There has been a movement away from the study of protease-antiprotease interactions in both experimental and clinical acute pancreatitis. Increasingly, the focus of the basic pathologic mechanism in acute pancreatitis reveals strong parallels with that of septic shock. Elevated levels of endotoxin, decreased levels of endogenous antiendotoxic core antibody, and elevated local levels (and less often, peripheral blood levels) of various cytokines are found in both conditions. Therapy to modify this response may prove valuable. Emphasis on new early methods of assessing prognosis continues and marked obesity has been shown as a significant marker of poor prognosis. Despite the lack of a specific large clinical trial categorically proving the place of early endoscopic retrograde cholangiopancreatography sphincterotomy, the trend of results in all studies indicates the value of this in those with severe acute pancreatitis. A consensus of experts has strongly suggested dropping confusing terminology such as ldquo;pancreatic phlegmonrdquo; and ldquo;infected pseudocystrdquo; while clarifying the disease description.
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