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A multicenter, randomized trial of patients with infected necrotizing pancreatitis evaluated immediate drainage within 24 hours after infected necrosis was diagnosed as compared with postponed drainage. Immediate drainage was not superior to postponed drainage in reducing complications. Patients assigned to immediate drainage underwent a greater number of invasive procedures.

In this trial in patients with acute pancreatitis, early tube feeding was not superior to an oral diet after 72 hours (with tube feeding if needed) in reducing the rate of major infection or death. In the oral-diet group, 69% of patients did not require tube feeding. Acute pancreatitis is the most common gastrointestinal disease leading to hospital admission, and its incidence continues to rise. 1 – 4 Most patients with acute pancreatitis recover uneventfully and are discharged after a few days. 5 , 6 In 20% of patients, the disease course is complicated by major infection, such as infected pancreatic necrosis, which is associated with a mortality of 15%. 7 – 11 A meta-analysis of eight randomized trials involving 348 patients showed that nasoenteric tube feeding, as compared with total parenteral nutrition, reduced the rate of infections and mortality among patients with severe pancreatitis. 12 These infections are thought to be mediated by . . .