Complicated Pancreatitis

Research questions addressed in this thesis: What is the accuracy of serum blood urea nitrogen as early predictor of complicated pancreatitis? ; What is difference in clinical outcome between patients with pancreatic parenchymal necrosis and patients with extrapancreatic necrosis without necrosis of the pancreatic parenchyma? ; What is the impact of organ failure on mortality in necrotizing pancreatitis? ; Based on individual patient data from randomized trials, does early enteral tube feeding improve outcome in patients with acute pancreatitis? ; Does early enteral tube feeding compared with an oral diet after 72 hours with tube feeding only if necessary, reduce the number of infections or death in patients with pancreatitis who are at risk for complications? ; What is the optimal timing of cholecystectomy following an attack of gallstone pancreatitis? ; Does a ‘step-up approach’, with the use of percutaneous drainage and minimally invasive necrosectomy if necessary, reduce the number of complications or death compared with primary open necrosectomy in patients with necrotizing pancreatitis? ; Does endoscopic transgastric necrosectomy compared with primary necrosectomy reduce the proinflammatory response and clinical outcome in patients with necrotizing pancreatitis? ; In patients with pancreatic fistulas following pancreatic necrosectomy, does endoscopic transpapillary stenting compared with conservative treatment reduce the time to fistula closure? ; What is the outcome of conservative and minimally invasive approaches in patients with necrotizing pancreatitis? ; What is the current state-of-the art approach to patients with necrotizing pancreatitis?