Management of Severe Acute Pancreatitis
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Pancreas (C Forsmark, Section Editor)
Management of Severe Acute Pancreatitis Peter J. Lee, MBChB1 Georgios I. Papachristou, MD, PhD2,* Address 1 Division of Gastroenterology and Hepatology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA *,2 Division of Gastroenterology and Hepatology, Department of Medicine, Ohio State University Wexner Medical Center, 410 W 10th Street, 2nd floor, Columbus, OH, 43210, USA Email: [email protected]
* Springer Science+Business Media, LLC, part of Springer Nature 2020
This article is part of the Topical Collection on Pancreas Keywords Severe pancreatitis I Organ failure I Inflammatory cytokines I Necrotizing pancreatitis
Abstract Purpose of review There have been significant advancements in different aspects of management of severe acute pancreatitis (SAP). Our review of the most recent literature focuses on severity prediction, fluid resuscitation, analgesic administration, nutrition, and endoscopic intervention for SAP and its extra-pancreatic complications. Recent findings Recent studies on serum cytokines for the prediction of SAP have shown superior prognostic performance when compared with conventional laboratory tests and clinical scoring systems. In patients with established SAP and vascular leak syndrome, intravenous fluids should be administered with caution to prevent intra-abdominal hypertension and volume overload. Endoscopic retrograde cholangiopancreatography improves outcomes only in AP patients with suspected cholangitis. Early enteral tubefeeding does not appear to be superior to on-demand oral feeding. Abdominal compartment syndrome is a highly lethal complication of SAP that requires percutaneous drainage or decompressive laparotomy. Endoscopic transmural drainage followed by necrosectomy (i.e., “step-up approach”) is the treatment strategy of choice in patients with symptomatic or infected walled-off pancreatic necrosis. Summary SAP is a complex clinical syndrome associated with a high mortality rate. Early prediction of SAP remains challenging due to the limited accuracy of the available prediction tools. Early fluid resuscitation, organ support, enteral nutrition, and prevention of/or prompt recognition of abdominal compartment syndrome remain cornerstones of its management. A step-up, minimally invasive drainage/debridement is the preferred approach for patients with infected pancreatic necrosis.
Pancreas (C Forsmark, Section Editor)
Introduction Acute pancreatitis (AP) is an acute inflammatory disease that results from pancreatic injury via various mechanisms [1••]. Its incidence is increasing worldwide, and it continues to be among the top causes of GI-related hospitalizations in the USA [2]. Several key pathophysiologic mechanisms of organ injury in AP have been recently identified [1••]. These include intra- and peripancreatic fat lipolysis, exaggerated immune response, and microvascular dysfunction leading to vascular leak syndrome [1••]. AP- and ischemiaconditioned mesenteric lymph is being
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