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An optimal treatment regimen for SAP should be established on the basis of individual patient characteristics (e.g., the underlying cause of pancreatitis, presence of associated injuries, severity of pancreatitis, patient's response to systemic analgesics, status of bowel hypoperistalsis, circulating blood volume, type and extent of pancreas injury), pharmacokinetic characteristics of administered drugs, as well as the need to correct any pre-existing comorbid conditions [51].
There are a number of therapeutic options ranging from analgesics and bed rest to nutritional supports such as parenteral nutrition and enteral nutrition. The optimal route of enteral nutrition is controversial. Enteral nutrition may be started through an endoscopic or surgical approach. In both cases, routine pre-treatment is required to reduce the risk of aspiration pneumonia (AP). In a randomized controlled trial, moderate to severe acute pancreatitis patients were randomized to nasoenteral tube placement or control (no tube) [31, 32]. In moderate acute pancreatitis, nasoenteral tube placement failed to reduce the incidence of clinical and radiological pancreatitis, other intestinal complications, or mortality. In severe acute pancreatitis, nasoenteral tube placement resulted in a lower incidence of necrotizing pancreatitis
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