Severe acute pancreatitis (SAP) is a rapid onset and complex acute digestive system emergency, often accompanied by severe local and systemic complications, leading to a high mortality rate. In recent years, with the continuous update of treatment concepts, especially the advancement of endoscopic and minimally invasive surgical techniques, the prognosis of SAP patients has significantly improved. However, in clinical practice, particularly in the early stages of the disease, there are still widespread issues of non-standard and imprecise diagnostic and therapeutic practices, which are important factors contributing to the occurrence of severe complications in the later stages of the disease and a major reason for the poor prognosis of SAP patients. In light of this, this article systematically reviews high-quality literature from recent years and combines the latest clinical research findings from the authors' team to summarize advancements in early precise diagnosis and treatment of SAP, providing new evidence for standardized treatment of SAP, which will undoubtedly help further improve the overall treatment outcomes for SAP.