Severe acute pancreatitis : Improving outcome

This thesis contains results of 8 years of clinical research performed to improve the treatment of patients with acute pancreatitis. The first part of this thesis focusses on diagnostics and the prevention of complications. The applicability of the revised Atlanta classification for acute pancreatitis and the expert panel, implemented by the Dutch Pancreatitis Study Group, are assessed. This panel is 24/7 available, provides free treatment counseling within 24 hours and is considered valuable by the consulted physicians. In addition, this thesis describes the natural course of collections and the development of gas in these collections over time. In contrast to previous opinions, most of the collections were already encapsulated 3 weeks after admission and only 50% of the patients actually developed gas in the collection. Furthermore, the results of the PYTHON trial show that early feeding of patients with predicted severe pancreatitis does not reduce the combined end point of infections and mortality. In the second part of this thesis, the research aims to improve treatment and outcome of severe acute pancreatitis. A surgical step-up approach with drainage as first step of treatment is the general treatment standard for this group of patients. This thesis confirms, within the largest international cohort of patients, that a minimally invasive step-up treatment indeed reduces the number of complications and mortality compared to traditionally open necrosectomy. Finally, this thesis shows that an endoscopic step-up treatment is safe, feasible and comparable to the 'current standard' minimally invasive step-up surgery.