Advertisement

Acute Pancreatitis: The Increasing Role of Medical Management of a Traditionally Surgically Managed Disease

Published:September 21, 2021DOI:https://doi.org/10.1016/j.amjmed.2021.08.021

      Abstract

      Management of acute pancreatitis and its complications has rapidly evolved in recent years. The earlier pillars of management that included prolonged bowel rest, empiric intravenous antibiotics, and early surgical intervention for complications such as pancreatic necrosis have become much less common. The latest evidence-based approaches to acute pancreatitis are taking almost a diametrically different path to previous management. The current strategy focuses on early feeding, judicious use of antibiotics, and delayed use of invasive interventions. Even in complex cases, when surgical interventions may be indicated, there is an expressed preference for minimally invasive techniques. We review the changes that have evolved rapidly over the past decade in this common clinical problem.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Yadav D
        • Lowenfels AB
        The epidemiology of pancreatitis and pancreatic cancer.
        Gastroenterology. 2013; 144: 1252-1261
        • Opie E
        The etiology of acute hemorrhagic pancreatitis.
        Bull Johns Hopkins Hosp. 1901; : 121-188
        • Halsted W
        Retrojection of bile into the pancreas, a cause of acute hemorrhagic pancreatitis.
        Bull Johns Hopkins Hosp. 1901; : 121-182
        • Warren KW
        • Veidenheimer M
        Pathological considerations in the choice of operation for chronic relapsing pancreatitis.
        N Engl J Med. 1962; 266: 323-329
        • Duval Jr, MK
        • Enquist IF
        The surgical treatment of chronic pancreatitis by pancreaticojejunostomy: an 8 year reappraisal.
        Surgery. 1961; 50: 965-969
        • Doubilet H
        • Mulholland JH
        Recurrent acute pancreatitis: observations on etiology and surgical treatment.
        Ann Surg. 1948; 128: 609-636
        • Bartlett MK
        • Nardi GL
        Treatment of recurrent pancreatitis by resection inhibition and retrograde drainage of the pancrease.
        Ann Surg. 1960; 152: 861-863
        • Ismail OZ
        • Bhayana V
        Lipase or amylase for the diagnosis of acute pancreatitis?.
        Clin Biochem. 2017; 50: 1275-1280
        • Working Party of the British Society of Gastroenterology
        • Association of Surgeons of Great Britain and Ireland
        • Pancreatic Society of Great Britain and Ireland
        • Association of Upper GI Surgeons of Great Britain and Ireland
        UK guidelines for the management of acute pancreatitis.
        Gut. 2005; 54: iii1-iii9
        • Yokoe M
        • Takada T
        • Mayumi T
        • et al.
        Japanese guidelines for the management of acute pancreatitis: Japanese guidelines 2015.
        J Hepatobiliary Pancreat Sci. 2015; 22: 405-432
        • Pezzilli R
        • Zerbi A
        • Di Carlo V
        • Bassi C
        • Delle Fave GF
        • Working Group of the Italian Association for the Study of the Pancreas on Acute Pancreatitis
        Practical guidelines for acute pancreatitis.
        Pancreatology. 2010; 10: 523-535
        • Spanier BW
        • Nio Y
        • van der Hulst RW
        • Tuynman HA
        • Dijkgraaf MG
        • Bruno MJ
        Practice and yield of early CT scan in acute pancreatitis: a Dutch observational multicenter study.
        Pancreatology. 2010; 10: 222-228
        • Tenner S
        • Baillie J
        • DeWitt J
        • Vege SS
        • American College of Gastroenterology
        American College of Gastroenterology guideline: management of acute pancreatitis.
        Am J Gastroenterol. 2013; 108 (1416): 1400-1415
        • Bollen TL
        • Singh VK
        • Maurer R
        • et al.
        A comparative evaluation of radiologic and clinical scoring systems in the early prediction of severity in acute pancreatitis.
        Am J Gastroenterol. 2012; 107: 612-619
        • Banks PA
        • Bollen TL
        • Dervenis C
        • et al.
        Classification of acute pancreatitis–2012: revision of the Atlanta classification and definitions by international consensus.
        Gut. 2013; 62: 102-111
        • Marshall JC
        • Cook DJ
        • Christou NV
        • Bernard GR
        • Sprung CL
        • Sibbald WJ
        Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome.
        Crit Care Med. 1995; 23: 1638-1652
        • Lankisch PG
        • Apte M
        • Banks PA
        Acute pancreatitis.
        Lancet. 2015; 386: 85-96
        • Wu BU
        • Hwang JQ
        • Gardner TH
        • et al.
        Lactated Ringer's solution reduces systemic inflammation compared with saline in patients with acute pancreatitis.
        Clin Gastroenterol Hepatol. 2011; 9 (e1): 710-717
        • Wu BU
        • Johannes RS
        • Sun X
        • Conwell DL
        • Banks PA
        Early changes in blood urea nitrogen predict mortality in acute pancreatitis.
        Gastroenterology. 2009; 137: 129-135
        • Petrov MS
        • Pylypchuk RD
        • Uchugina AF
        A systematic review on the timing of artificial nutrition in acute pancreatitis.
        Br J Nutr. 2009; 101: 787-793
        • Pederzoli P
        • Bassi C
        • Vesentini S
        • Campedelli A
        A randomized multicenter clinical trial of antibiotic prophylaxis of septic complications in acute necrotizing pancreatitis with imipenem.
        Surg Gynecol Obstet. 1993; 176: 480-483
        • Steinberg W
        • Tenner S
        Acute pancreatitis.
        N Engl J Med. 1994; 330: 1198-1210
        • Wittau M
        • Mayer B
        • Scheele J
        • Henne-Bruns D
        • Dellinger EP
        • Isenmann R
        Systematic review and meta-analysis of antibiotic prophylaxis in severe acute pancreatitis.
        Scand J Gastroenterol. 2011; 46: 261-270
        • Villatoro E
        • Mulla M
        • Larvin M
        Antibiotic therapy for prophylaxis against infection of pancreatic necrosis in acute pancreatitis.
        Cochrane Database Syst Rev. 2010; CD002941
        • Rattner DW
        • Legermate DA
        • Lee MJ
        • Mueller PR
        • Warshaw AL
        Early surgical debridement of symptomatic pancreatic necrosis is beneficial irrespective of infection.
        Am J Surg. 1992; 163: 105-109
        • Ranson JH
        • Berman RS
        Long peritoneal lavage decreases pancreatic sepsis in acute pancreatitis.
        Ann Surg. 1990; 211 (708-8)
        • Runzi M
        • Niebel W
        • Goebell H
        • Gerken G
        • Layer P
        Severe acute pancreatitis: nonsurgical treatment of infected necroses.
        Pancreas. 2005; 30: 195-199
        • van Santvoort HC
        • Besselink MG
        • Bakker OJ
        • et al.
        A step-up approach or open necrosectomy for necrotizing pancreatitis.
        N Engl J Med. 2010; 362: 1491-1502
        • Freeman ML
        • Werner J
        • van Santvoort HC
        • et al.
        Interventions for necrotizing pancreatitis: summary of a multidisciplinary consensus conference.
        Pancreas. 2012; 41: 1176-1194
        • Varadarajulu S
        • Christein JD
        • Tamhane A
        • Drelichman ER
        • Wilcox CM
        Prospective randomized trial comparing EUS and EGD for transmural drainage of pancreatic pseudocysts (with videos).
        Gastrointest Endosc. 2008; 68: 1102-1111
        • Leppaniemi A
        • Tolonen M
        • Tarasconi A
        • et al.
        2019 WSES guidelines for the management of severe acute pancreatitis.
        World J Emerg Surg. 2019; 14 (14:2714:27): 27
        • Senn N
        Surgery of the pancreas as based upon experiments and clinical researches.
        Trans An Surg Assoc. 1886; 4: 99-123
        • Bakker OJ
        • van Santvoort HC
        • van Brunschot S
        • et al.
        Endoscopic transgastric vs surgical necrosectomy for infected necrotizing pancreatitis: a randomized trial.
        JAMA. 2012; 307: 1053-1061
        • Moraes JM
        • Felga GE
        • Chebli LA
        • et al.
        A full solid diet as the initial meal in mild acute pancreatitis is safe and result in a shorter length of hospitalization: results from a prospective, randomized, controlled, double-blind clinical trial.
        J Clin Gastroenterol. 2010; 44: 517-522
        • Eckerwall GE
        • Axelsson JB
        • Andersson RG
        Early nasogastric feeding in predicted severe acute pancreatitis: A clinical, randomized study.
        Ann Surg. 2006; 244 (discussion 965-967): 959-965
        • van Brunschot S
        • van Grinsven J
        • van Santvoort HC
        • et al.
        Endoscopic or surgical step-up approach for infected necrotising pancreatitis: A multicentre randomised trial.
        Lancet. 2018; 391: 51-58
        • van Santvoort HC
        • Bakker OJ
        • Bollen TL
        • et al.
        A conservative and minimally invasive approach to necrotizing pancreatitis improves outcome.
        Gastroenterology. 2011; 141: 1254-1263
        • Boxhoorn Lotte
        • et al.
        Immediate versus Postponed Intervention for Infected Necrotizing Pancreatitis.
        New England Journal of Medicine. 2021; 385: 1372-1381