2022 WATERFALL TRIAL Aggressive or moderate fluid resuscitation in acute pancreatitis multicenter, open-label, parallel-group, superiority, randomized controlled trial Objective: To evaluate the safety & efficacy of aggressive fluid resuscitation as compared with moderate fluid resuscitation for the management of acute pancreatitis 249 patients Patients ≥18 yrs with acute pancreatitis (Revised Atlanta Classification-meeting 2 of the following 3 criteria: typical abdominal pain, serum amylase or lipase level >3 times the upper limit, or signs of acute pancreatitis on imaging) who presented ≤ 24 hrs after pain onset & diagnosed ≤ 8 hrs before enrollment VS Aggressive fluid resuscitation (n=122) Moderate fluid resuscitation (n=127) 22.1 PRIMARY OUTCOME Moderately severe or severe pancreatitis % RR 1.30; 95% CI, 0.78 to 2.18; P=0.32 SECONDARY OUTCOMES 17.3 Fluid Overload % 20.5 6.3 RR, 2.85; 95% CI, 1.36 to 5.94, P=0.004 Severe pancreatitis % 6.6 RR 2.69; 95% CI, 0.56 to 12.88 1.6 20.5 Any local complication% RR 1.28; 95% CI, 0.74 to 2.22 16.5 Conclusion: Among patients with acute pancreatitis, early aggressive fluid resuscitation resulted in a higher incidence of fluid overload without improvement in clinical outcomes. E de-Madaria et al. NEJM 2022; 387:989-1000