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With the characteristics of complicated etiologic factors,multiple complications and high mortality,severe acute pancreatitis (SAP) has been treated by all kinds of clinical management.Management of SAP is a hot topic in recent decades.Researches on the pathophysiology of SAP have advanced dramatically during the past 20 years.As the number of randomized controlled studies of SAP has steadily increased,mainly in the United States and Europe,evidence based management was demanded for the management of SAP.The main improvement of the treatment results was achieved following internationally accepted recommendations; however,some aspects of the management are different and need to be discussed.There has been no consensus regarding the treatment of SAP.Failure to provide definitive treatment may potentially put a patient at risk of a fatal episode of SAP.The aims of this study,therefore,were to survey the currently adopted practice of the management of SAP,to evaluate the impact of various subspecialty interests on the practice adopted,and to suggest pathways towards a better implementation of the guidelines and other evidence-based management approaches.