Central European Journal of Medicine

, Volume 9, Issue 4, pp 594–600 | Cite as

Evidence-based management of pancreatitis

  • Natalia Zambudio
  • Karim Muffak
  • Trinidad Villegas
  • Antonio Becerra
  • Yillian Fundora
  • Daniel Garrote
  • Antonio Ferrón
Review Article



We review the most recent advances in the management of pancreatitis following publication of the latest clinical practice guidelines. The most significant innovations have taken place in the surgical treatment of pancreatitis, specifically regarding when a patient should be intervened and what procedure should be used. Moreover, changes that have occurred in the classification of pancreatitis seek to harmonize diagnostic criteria and facilitate comparisons among centers.


We reviewed three of the latest guidelines and review articles published since 2008 following an electronic search through Medline, Embase and the Cochrane Library.


Although diverse guidelines and review articles coincide on many key points, they need to be updated with regard to the numerous surgical innovations that have emerged recently in the management of pancreatitis.


Pancreatitis Evidence based medicine Review Guidelines Management Diagnostic imaging Treatment 


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  1. [1]
    Bradley EL. A clinically-based classification system for acute pancreatitis. Summary of the International Symposium on Acute Pancreatitis, Atlanta Ga, September 11 through 13, 1992. Arch Surg. 1993 May;128(5):586–590PubMedCrossRefGoogle Scholar
  2. [2]
    Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, et al. Classification of acute pancreatitis-2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013 Jan;62(1):102–111PubMedCrossRefGoogle Scholar
  3. [3]
    Bradley EL. Atlanta Redux: revisiting the severity stratification system for acute pancreatitis. Ann Surg. 2012 Dec;256(6):881–882PubMedCrossRefGoogle Scholar
  4. [4]
    Dellinger EP, Forsmark CE, Layer P, Levy P, Maraví-Poma E, Petrov MS, et al. Determinant-Based Classification of Acute Pancreatitis Severity: An International Multidisciplinary Consultation. Ann Surg. 2012 Dec;256(6):875–880PubMedCrossRefGoogle Scholar
  5. [5]
    UK guidelines for the management of acute pancreatitis. Gut. 2005 May;54Suppl 3:iii1–9Google Scholar
  6. [6]
    Shah AM, Eddi R, Kothari ST, Maksoud C, DiGiacomo WS, Baddoura W. Acute pancreatitis with normal serum lipase: a case review. JOP. 2010 Jul 5;11(4):369–372PubMedGoogle Scholar
  7. [7]
    Lippi G, Valentino M, Cervellin G. Laboratory diagnosis of acute pancreatitis: in search of the Holy Grail. Crit Rev Clin Lab Sci. 2012 Jan;49(1):18–31PubMedCrossRefGoogle Scholar
  8. [8]
    Pezzilli R, Zerbi A, Di Carlo V, Bassi C, Delle Fave GF. Practical Guidelines for Acute Pancreatitis. Pancreatology. 2010;10(5):523–535PubMedCrossRefGoogle Scholar
  9. [9]
    Dambrauskas Z, Gulbinas A, Pundzius J, Barauskas G. Value of the different prognostic systems and biological markers for predicting severity and progression of acute pancreatitis. Scand J Gastroenterol. 2010 Aug;45(7–8):959–970PubMedCrossRefGoogle Scholar
  10. [10]
    Mounzer R, Langmead CJ, Wu BU, Evans AC, Bishehsari F, Muddana V, et al. Comparison of Existing Clinical Scoring Systems to Predict Persistent Organ Failure in Patients With Acute Pancreatitis. Gastroenterology. 2012 Jun;142(7):1476–1482PubMedCrossRefGoogle Scholar
  11. [11]
    Garcea G, Gouda M, Hebbes C, Ong SL, Neal CP, Dennison AR, et al. Predictors of Severity and Survival in Acute Pancreatitis: Validation of the Efficacy of Early Warning Scores. Pancreas. 2008 Oct;37(3):e54–61PubMedCrossRefGoogle Scholar
  12. [12]
    Balthazar EJ, Freeny PC, vanSonnenberg E. Imaging and intervention in acute pancreatitis. Radiology. 1994 Nov;193(2):297–306PubMedCrossRefGoogle Scholar
  13. [13]
    Takada T, Kawarada Y, Hirata K, Mayumi T, Yoshida M, Sekimoto M, et al. Guidelines for the management of acute pancreatitis. J Hepatobiliary Pancreat Surg. 2006;13(1):1–67PubMedCentralCrossRefGoogle Scholar
  14. [14]
    Mortele KJ, Wiesner W, Intriere L, Shankar S, Zou KH, Kalantari BN, et al. A Modified CT Severity Index for Evaluating Acute Pancreatitis: Improved Correlation with Patient Outcome. AJR Am J Roentgenology. 2004 Nov;183(5):1261–1265CrossRefGoogle Scholar
  15. [15]
    Mirtallo JM, Forbes A, McClave SA, Jensen GL, Waitzberg DL, Davies AR, et al. International Consensus Guidelines for Nutrition Therapy in Pancreatitis. JPEN J Parenteral Enteral Nutr. 2012 May;36(3):284–291CrossRefGoogle Scholar
  16. [16]
    Banks PA, Freeman ML. Practice Parameters Committee of the American College of Gastroenterology, Practice guidelines in acute pancreatitis. Am J Gastroenterol. 2006 Oct;101(10):2379–2400PubMedCrossRefGoogle Scholar
  17. [17]
    Ong JP, Fock KM. Nutritional support in acute pancreatitis. J Dig Dis. 2012 Sep;13(9):445–452PubMedCrossRefGoogle Scholar
  18. [18]
    Jiang K, Huang W, Yang XN, Xia Q. Present and future of prophylactic antibiotics for severe acute pancreatitis. World J Gastroenterol. 2012 Jan21;18(3):279–284CrossRefGoogle Scholar
  19. [19]
    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 of Gastroenterol. 2011;46(3):261–270CrossRefGoogle Scholar
  20. [20]
    Tse F, Yuan Y. Early routine endoscopic retrograde cholangiopancreatography strategy versus early conservative managemenet strategy in acute gallstone pancreatitis. Cochrane Database Syst Rev. 2012 May 16;5:CD009779Google Scholar
  21. [21]
    Nguyen GC, Rosenberg M, Chong RY, Chong CA. Early cholecystectomy and ERCP are associated with reduced readmisions for acute biliary pancreatitis: a nationwide, population-based study. Gastrointest Endosc. 2012 Jan;75(1):47–55PubMedCrossRefGoogle Scholar
  22. [22]
    van Baal MC, Besselink MG, Bakker OJ, van Santvoort HC, Schaapherder AF, Nieuwenhuijs VB, et al. Timing of cholecystectomy after mild biliary pancreatitis: a systematic review. Ann Surg. 2012 May;255(5):860–866PubMedCrossRefGoogle Scholar
  23. [23]
    van Brunschot S, Bakker OJ, Besselink MG, Bollen TL, Fockens P, Gooszen HG, et al. Treatment of necrotizing pancreatitis. Clin Gastroenterol Hepatol. 2012 Nov;10(11):1190–201PubMedCrossRefGoogle Scholar
  24. [24]
    Buckminster Farrow, Daniel Albo, David H Berger. The role of the tumor microenvironment in the progression of pancreatic cancer. J Surg Res. 2008;149(2):319–328PubMedCrossRefGoogle Scholar
  25. [25]
    Easler JJ, Zureikat A, Papachristou GI. An update on minimally invasive therapies for pancreatic necrosis. Expert Rev Gastroenterol Hepatol. 2012 Dec;6(6):745–753PubMedCrossRefGoogle Scholar
  26. [26]
    Haghshenasskashani A, Laurence JM, Kwan V, Johnston E, Holands MJ, Richardson AJ, et al. Endoscopic necrosectomy of pancreatic necrosis: a systematic review. Surg Endosc. 2011 Dec;25(12):3724–3730PubMedCrossRefGoogle Scholar

Copyright information

© Versita Warsaw and Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Natalia Zambudio
    • 1
  • Karim Muffak
    • 1
  • Trinidad Villegas
    • 1
  • Antonio Becerra
    • 1
  • Yillian Fundora
    • 1
  • Daniel Garrote
    • 1
  • Antonio Ferrón
    • 1
  1. 1.Department of Surgery. Unit of Hepatobiliary SurgeryHospital Universitario Virgen de las NievesGranadaSpain

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