Current Treatment Options in Gastroenterology

, Volume 6, Issue 5, pp 381–387 | Cite as

Medical and endoscopic treatment of acute pancreatitis

  • William B. Silverman

Opinion statement

Accurate diagnosis of acute pancreatitis and assessment of disease severity is crucial. Multiorgan failure predicts a poorer prognosis. Treatment of acute biliary pancreatitis by endoscopic retrograde cholangiopancreatography (ERCP) may improve overall prognosis. Referral of seriously ill or unstable patients to a specialized center is recommended. Managing teams must be vigilant regarding the avoidance of iatrogenic complications, such as endoscopic misadventure or inadvertent line sepsis. Large, multicenter endoscopic outcome trials for prevention of ERCP-related pancreatitis, and to determine efficacy of treatment of acute gallstone pancreatitis, are needed.


Pancreatitis Acute Pancreatitis Severe Acute Pancreatitis Main Drug Interaction Pefloxacin 
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References and Recommended Reading

  1. 1.
    Ranson JH, Rifkind KM, Roses DF, et al.: Prognostic signs and the role of operative management in acute pancreatitis. Surg Gynecol Obstet 1974, 139:69–81.PubMedGoogle Scholar
  2. 2.
    Blamey SL, Imrie CW, O’Neill J, et al.: Prognostic factors in acute pancreatitis. Gut 1984, 25:1340–1346.PubMedGoogle Scholar
  3. 3.
    Toouli J, Brooke-Smith M, Bassi C, et al.: Guidelines for the management of acute pancreatitis: a working party report. J Gastroenterol Hepatol 2002, 17(suppl):S15-S39. Working party consensus article done by a panel of recognized experts, with stratified reference list and quality evaluation and categorization of each reference.PubMedCrossRefGoogle Scholar
  4. 4.
    Acosta JM, Ledesma CL: Gallstone migration as a cause of acute pancreatitis. N Engl J Med 1974, 290:484–487.PubMedCrossRefGoogle Scholar
  5. 5.
    Kozarek R: Role of ERCP in acute pancreatitis. Gastrointest Endosc 2002, 56(suppl 6):231–236.CrossRefGoogle Scholar
  6. 6.
    United Kingdom guidelines for the management of acute pancreatitis. Gut 1998, 42:S1–S13.Google Scholar
  7. 7.
    Meier R, Beglinger C, Layer P, et al.: ESPEN guidelines on nutrition in acute pancreatitis. Clin Nutr 2002, 21:173–183.PubMedCrossRefGoogle Scholar
  8. 8.
    Imrie CW, Carter CR, McKay CJ: Enteral and parenteral nutrition in acute pancreatitis. Best Practice Res Clin Gastroenterol 2002, 16:391–397.CrossRefGoogle Scholar
  9. 9.
    Abou-Assi S, O’Keefe SJ: Nutrition support during acute pancreatitis. Nutrition 2002, 18:938–943.PubMedCrossRefGoogle Scholar
  10. 10.
    Kalfarentzos F, Kehagias J, Mead N, et al.: Enteral nutrition is superior to parenteral nutrition in severe acute pancreatitis: results of a randomized prospective trial. Br J Surg 1997, 84:1665–1669.PubMedCrossRefGoogle Scholar
  11. 11.
    McClave SA, Greene LM, Snider HL, et al.: Comparison of the safety of early enteral vs parenteral nutrition in mild acute pancreatitis. J Parenter Enteral Nutr 1997, 21:14–20.CrossRefGoogle Scholar
  12. 12.
    Trice S, Melnik G, Page CP: Complications and costs of early postoperative parenteral versus enteral nutrition in trauma patients. Nutr Clin Pract 1997, 12:114–119.CrossRefGoogle Scholar
  13. 13.
    Heyland DK, Novak F, Drover JW, et al.: Should immunonutrition become routine in critically ill patients? A systematic review of the evidence. JAMA 2001, 286:944–953.PubMedCrossRefGoogle Scholar
  14. 14.
    Levy P, Heresbach D, Pariente EA, et al.: Frequency and risk factors of recurrent pain during refeeding in patients with acute pancreatitis: a multivariate multicenter prospective study of 116 patients. Gut 1997, 40:262–266.PubMedGoogle Scholar
  15. 15.
    Andriulli A, Clemente R, Solmi L, et al.: Gabexate or somatostatin administration before ERCP in patients at high risk for post-ERCP pancreatitis: a multicenter, placebo-controlled, randomized clinical trial. Gastrointest Endosc 2002, 56:488–495.PubMedCrossRefGoogle Scholar
  16. 16.
    Abu-Zidan FM, Windsor JA: Lexipafant and acute pancreatitis: a critical appraisal of the clinical trials. Eur J Surg 2002, 168:215–219.PubMedCrossRefGoogle Scholar
  17. 17.
    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.PubMedGoogle Scholar
  18. 18.
    Bassi C, Falconi M, Talamini G, et al.: Controlled clinical trial of pefloxacin versus imipenem in severe acute pancreatitis. Gastroenterology 1998, 115:1515–1517.CrossRefGoogle Scholar
  19. 19.
    Sainio V, Kemppainen E, Puolakkainen P, et al.: Early antibiotic treatment in acute necrotizing pancreatitis. Lancet 1995, 346:663–666.PubMedCrossRefGoogle Scholar
  20. 20.
    Robbins EG, Stollman NH, Bierman P, et al.: Pancreatic fungal infections: a case report and review literature. Pancreas 1996, 12:308–312.PubMedCrossRefGoogle Scholar
  21. 21.
    Grewe M, Tsiotos GG, Luque de-Leon E, Sarr MG: Fungal infection in acute necrotizing pancreatitis. J Am Coll Surg 1999, 188:408–414.PubMedCrossRefGoogle Scholar
  22. 22.
    Eatock FC, Brombacher GD, Steven A, et al.: Nasogastric feeding in severe acute pancreatitis may be practical and safe. Int J Pancreatol 2000, 28:23–29.PubMedGoogle Scholar
  23. 23.
    Banks PA: Infected necrosis: morbidity and therapeutic consequences. Hepato-gastroenterol 1991, 38:116–119.Google Scholar
  24. 24.
    Neoptolemos JP, London NJ, James D, et al.: Controlled trial of urgent endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy versus conservative treatment for acute pancreatitis due to gallstones. Lancet 1988, 2:979–983.PubMedCrossRefGoogle Scholar
  25. 25.
    Fan ST, Lai EC, Mok FP, et al.: Early treatment of acute biliary pancreatitis by endoscopic papillotomy. N Engl J Med 1993, 328:228–232.PubMedCrossRefGoogle Scholar
  26. 26.
    Folsch UR, Nitsche R, Ludtke R, et al., and the German Study Group on Acute Biliary Pancreatitis: Early ERCP and papillotomy compared with conservative treatment for acute biliary pancreatitis. N Engl J Med 1997, 336:237–242.PubMedCrossRefGoogle Scholar
  27. 27.
    Nowak A, Nowakowska-Dulawa E, Marek TA, et al.: Final results of the prospective, randomized controlled study on endoscopic sphincterotomy versus conventional management in acute biliary pancreatitis. Gastroenterology 1995, 108:A380.Google Scholar
  28. 28.
    Steinberg WM, Neoptolemos JP, Folsch UR, Layer P: Controversies in clinical pancreatology. The management of severe gallstone pancreatitis. Pancreas 2001, 22:221–229. Discussion of possible reasons for the differences in outcomes between three major studies examining the benefit of ERCP for the management of acute gallstone pancreatitis.PubMedCrossRefGoogle Scholar
  29. 29.
    Folsch UR: Letter to the Editor. Pancreas 2003, 24:412–418.CrossRefGoogle Scholar
  30. 30.
    Mark DH, Lefevre F, Flamm CR, Aronson N: Evidencebased assessment of ERCP in the treatment of pancreatitis. Gastrointest Endoscop 2002, 56(suppl 6):S249-S254. Results of a recent National Institutes of Health conferenc examining clinical outcomes of ERCP.CrossRefGoogle Scholar
  31. 31.
    Chang L, Lo S, Stabile BE, et al.: Preoperative versus postoperative endoscopic retrograde cholangiopancreatography in mild to moderate pancreatitis: a prospective randomized trial. Ann Surg 2000, 231:82–87.PubMedCrossRefGoogle Scholar
  32. 32.
    Aiyer MK, Burdick JS, Sonnenberg A: Outcomes of surgical and endoscopic management ofbiliary pancreatitits. Dig Dis Sci 1999, 44:1684–1690.PubMedCrossRefGoogle Scholar
  33. 33.
    Kozarek RA, Ball TJ, Patterson DJ, et al.: Endoscopic transpapillary therapy for disrupted pancreatic duct and peripancreatic fluid collections. Gastroenterology 1971, 100:1362–1370.Google Scholar
  34. 34.
    Cremer M, Deviere J, Engelholm L: Endoscopic management of cysts and pseudocysts in chronic pancreatitis —long-term follow-up after 7 years of experience. Gastrointest Endosc 1989, 35:1–9.PubMedCrossRefGoogle Scholar
  35. 35.
    Baron TH, Harewood GC, Morgan DE, Yates MR: Outcome differences after endoscopic drainage of pancreatic necrosis, acute pancreatic pseudocysts, and chronic pancreatic pseudocysts. Gastrointest Endosc 2002, 56:7–17.PubMedCrossRefGoogle Scholar
  36. 36.
    Baron TH, Thaggard WG, Morgan DE, Stanley RJ: Endoscopic therapy for organized pancreatic necrosis. Gastroenterology 1996, 111:755–764.PubMedCrossRefGoogle Scholar
  37. 37.
    Cortes ES, Maalak A, LeMoine O, et al.: Endoscopic cystenterostomy of nonbulging pancreatic fluid colletions. Gastrointest Endosc 2002, 56:157–165.CrossRefGoogle Scholar
  38. 38.
    Rabenstein T, Roggenbuck S, Framke B, et al.: Complications of endoscopic sphincterotomy: can heparin prevent acute pancreatitis after ERCP? Gastrointest Endosc 2002, 55:476–483.PubMedCrossRefGoogle Scholar
  39. 39.
    Freeman ML, Nelson DB, Sherman S, et al.: Complications of endoscopic biliary sphincterotomy. N Engl J Med 1996, 335:909–918.PubMedCrossRefGoogle Scholar
  40. 40.
    Tarnasky PR, Palesch YY, Cunningham JT, et al.: Pancreatic stenting prevents pancreatitis after biliary sphincterotomy in patients with sphincter of Oddi dysfunction. Gastroenterology 1998, 115:1518–1524.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc 2003

Authors and Affiliations

  • William B. Silverman
    • 1
  1. 1.Division of Gastroenterology/HepatologyUniversity of Iowa Hospitals & ClinicsIowa CityUSA

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