Initial Management of Acute Pancreatitis

The initial management of AP is continually evolving, with new evidence challenging previous practices and influencing clinical approaches. Severity prediction tools are currently not accurate. Goal-directed moderate FR is now preferred over aggressive FR due to the harmful outcomes associated with the latter. Effective pain management and early oral nutrition are crucial components. Antibiotics and antifungal therapy should be administered only when suspected of infected pancreatic necrosis or other concomitant infections rather than for prophylactic purposes. Procalcitonin can help decide whether to start antibiotics. Urgent ERCP should be reserved for cases involving acute cholangitis. The etiology of AP should be addressed to avoid relapse. Same-admission cholecystectomy in mild biliary AP can reduce AP recurrence. Some gaps remain in the initial management of AP. New studies are underway and will bring new insights to this topic.