With interest we read the randomized study by Zerem et al. [1] regarding the drainage of sterile fluid collections in acute pancreatitis. The authors are to be commended for performing a randomized trial in a difficult patient population.Nearly all international guidelines advocate conservative management of sterile fluid collections in acute pancreatitis: (a) the American Gastroenterological Association (2007): "Acute fluid collections around the pancreas in the setting of acute pancreatitis require no therapy in the absence of infection or obstruction of a surrounding hollow viscus" [2], (b) the American College of Gastroenterology (2006): "Most peripancreatic fluid collections remain sterile and will disappear during the recovery from acute pancreatitis" [3], and (c) the international consensus meeting on treatment of acute pancreatitis (2004): "Routine operative or percutaneous drainage of the former (...peripancreatic fluid collections and pancreatic necrosis...) is not necessary and may infect otherwise sterile tissues" [4].
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