Omega-3 therefore are useful on early stages because shift inflammatory response at lower level, avoiding promotion active and powerful components production. As a matter of fact, immune response is always present, but it is ��modulated��, that means a reduction at lower level of response with production of leukotriens-3 instead of 4, and same for interleukine 4 instead of 3. Fibers should be always administered as colonic mucosa protection, as they have minimal effect on onset of diarrhea usually determined by antibiotic therapies. Calories amount must be administered on basis of indirect calorimetry to patients with respiratory failure and so we supply no more than 30 Kcal/h/day. Usually, we start with parenteral and enteral nutrition, increasing gradually enteral diet till full regimen.

We use industrial bag cheaper than home-made-nutrition bag. Evaluation of nutrition effectiveness was made by monitoring value of albumin and pre-albumin every 4 days. During first disease week, patients hard suffer high amount of EN into duodenum, for that we prefer to administer parenteral mixture of LCT plus MCT, as Nutriplus 1875/ml B. Braun, Melsungen, EU. Supply of EN was started at 20 ml/hour and increased every day 25 ml till full regimen; we initially used a polymeric diet mixture, and switching to an enriched one on fibers and glutamin at least 25 g/day, as soon as possible according to patient compliance. Nutritional supply was provided mainly by carbohydrates, otherwise lipids are increasingly supplied as greater caloric burden on less fluid quantities.

This is very important for a disease storing large quantity of fluids in retroperitoneal tissue. Discussion regarding the use of antibiotic drugs is still open. Wide action of these drugs are used as antifungal purpose too. Today, great importance on relief of intra-abdominal pressure (IAP) is assumed, and it is possible with monitoring of pressure value on urinary bladder. Resolution of cholecystitis is important and possible by avoiding impact to pancreatic tissue of stones migration. When patient has got inflammation of gallbladder and liver enzymes increase, cholecystostomy does immediate improvement. EN administration is started immediately after naso-jejunal feeding tube positioning. Nowadays, we perform it by endoscopic way, quicker and safer.

In the past, usually we inserted Bengmark self-propelling naso-jejunal tube or on fewer cases so called Tiger Tube?, Cook Medical. Anyway, we emphasize Carfilzomib importance of endoscopic service and not only to insert nutritional tubes, but also to remove necrotic debris by fistuloscopy. This procedures allow faster healing with the possibility to perform multiple procedures with good patient compliance. Fistuloscopy is proposed as complementary method after radiologic drainage, and integrated with other methods such as ultrasound -guided transgastric or transduodenal drainage.