OBJECTIVE To investigate the efficacy of somatostatin for the treatment of severe acute pancreatitis. METHODS Prospective, randomized and unblinded study. METHODS A general intensive care unit (ICU) in a university hospital. METHODS 50 patients with severe acute pancreatitis. METHODS All patients received the conventional treatment for this clinical condition. The study group received, in addition, somatostatin over a 10-day period. RESULTS We evaluated age, gender, etiology of the pancreatitis, severity of the illness, complications, length of hospitalization, and mortality in the ICU. The patients were classified as severe (Acute Physiology and Chronic Health Evaluation II score, Ranson's criteria, and computed tomography Balthazar classification). Biliary lithiasis was the most common etiologic factor (63.6% in the control group, 37.5% in study group; NS). The study group required fewer overall surgical interventions than the control group (45.8 vs 86.4%; p = 0.005). Late surgical procedures related to the evolution of pancreatic necrosis were more common in the controls (63.6 vs 37.5%; p = 0.07). No differences in length of stay in hospital or mortality in the ICU were observed. CONCLUSIONS The only advantage of somatostatin administration in the patients studied was a slight reduction in the need for surgery due to local complications.