PDF
ePub
Citation
Print
Abstract
Acute pancreatitis is common but remains a condition with significant morbidity and mortality. Despite a better understanding of the pathophysiology of acute pancreatitis achieved during the past few decades, there is no specific pharmacologic entity available. Therefore, supportive care is still the mainstay of treatment. Recently, novel interventions for increasing survival and minimizing morbidity have been investigated, which are highlighted in this review.
References
1. Meng W, Yuan J, Zhang C, et al. Parenteral analgesics for pain relief in acute pancreatitis: a systematic review. Pancreatology. 2013; 13:201–206.
2. Johnson CD, Besselink MG, Carter R. Acute pancreatitis. BMJ. 2014; 349:g4859.
3. American Society of Anesthesiologists Task Force on Acute Pain Management. Practice guidelines for acute pain management in the perioperative setting: an updated report by the American Society of Anesthesiologists Task Force on Acute Pain Management. Anesthesiology. 2012; 116:248–273.
4. Baillargeon JD, Orav J, Ramagopal V, Tenner SM, Banks PA. Hemoconcentration as an early risk factor for necrotizing pancreatitis. Am J Gastroenterol. 1998; 93:2130–2134.
5. Wall I, Badalov N, Baradarian R, Iswara K, Li JJ, Tenner S. Decreased mortality in acute pancreatitis related to early aggressive hydration. Pancreas. 2011; 40:547–550.
6. Warndorf MG, Kurtzman JT, Bartel MJ, et al. Early fluid resuscitation reduces morbidity among patients with acute pancreatitis. Clin Gastroenterol Hepatol. 2011; 9:705–709.
7. Gardner TB, Vege SS, Chari ST, et al. Faster rate of initial fluid resuscitation in severe acute pancreatitis diminishes in-hospital mortality. Pancreatology. 2009; 9:770–776.
8. Gardner TB, Vege SS, Pearson RK, Chari ST. Fluid resuscitation in acute pancreatitis. Clin Gastroenterol Hepatol. 2008; 6:1070–1076.
9. de-Madaria E, Soler-Sala G, Sánchez-Payá J, et al. Influence of fluid therapy on the prognosis of acute pancreatitis: a prospective cohort study. Am J Gastroenterol. 2011; 106:1843–1850.
10. Zhang W, Kim D, Philip E, et al. Gluco VIP study. A multinational, observational study to investigate the efficacy, safety and tolerability of acarbose as add-on or monotherapy in a range of patients: the Gluco VIP study. Clin Drug Investig. 2013; 33:263–274.
11. Mao EQ, Fei J, Peng YB, Huang J, Tang YQ, Zhang SD. Rapid he-modilution is associated with increased sepsis and mortality among patients with severe acute pancreatitis. Chin Med J (Engl). 2010; 123:1639–1644.
12. Haydock MD, Mittal A, Wilms HR, Phillips A, Petrov MS, Windsor JA. Fluid therapy in acute pancreatitis: anybody's guess. Ann Surg. 2013; 257:182–188.
13. 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; 9:710–717.
14. Wu BU, Bakker OJ, Papachristou GI, et al. Blood urea nitrogen in the early assessment of acute pancreatitis: an international validation study. Arch Intern Med. 2011; 171:669–676.
15. Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology. 2013; 13(4 Suppl 2):e1–e15.
16. Phillips CR, Vinecore K, Hagg DS, et al. Resuscitation of haemorrhagic shock with normal saline vs. lactated Ringer's: effects on oxygenation, extravascular lung water and haemodynamics. Crit Care. 2009; 13:R30.
17. Zhao G, Zhang JG, Wu HS, et al. Effects of different resuscitation fluid on severe acute pancreatitis. World J Gastroenterol. 2013; 19:2044–2052.
18. 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; 108:1400–1415.
19. Wang MD, Ji Y, Xu J, Jiang DH, Luo L, Huang SW. Early goal-directed fluid therapy with fresh frozen plasma reduces severe acute pancreatitis mortality in the intensive care unit. Chin Med J (Engl). 2013; 126:1987–1988.
20. Gardiner KR, Kirk SJ, Rowlands BJ. Novel substrates to maintain gut integrity. Nutr Res Rev. 1995; 8:43–66.
21. Versleijen MW, Oyen WJ, Roelofs HM, et al. Immune function and leukocyte sequestration under the influence of parenteral lipid emulsions in healthy humans: a placebo-controlled crossover study. Am J Clin Nutr. 2008; 87:539–547.
22. Al-Omran M, Albalawi ZH, Tashkandi MF, Al-Ansary LA. Enteral versus parenteral nutrition for acute pancreatitis. Cochrane Database Syst Rev. 2010; (1):CD002837.
23. Sun JK, Mu XW, Li WQ, Tong ZH, Li J, Zheng SY. Effects of early enteral nutrition on immune function of severe acute pancreatitis patients. World J Gastroenterol. 2013; 19:917–922.
24. Bakker OJ, van Brunschot S, van Santvoort HC, et al. Dutch Pancreatitis Study Group. Early versus on-demand nasoen-teric tube feeding in acute pancreatitis. N Engl J Med. 2014; 371:1983–1993.
25. Singh N, Sharma B, Sharma M, et al. Evaluation of early enteral feeding through nasogastric and nasojejunal tube in severe acute pancreatitis: a noninferiority randomized controlled trial. Pancreas. 2012; 41:153–159.
26. Eatock FC, Chong P, Menezes N, et al. A randomized study of early nasogastric versus nasojejunal feeding in severe acute pancreatitis. Am J Gastroenterol. 2005; 100:432–439.
27. Kumar A, Singh N, Prakash S, Saraya A, Joshi YK. Early enteral nutrition in severe acute pancreatitis: a prospective randomized controlled trial comparing nasojejunal and nasogastric routes. J Clin Gastroenterol. 2006; 40:431–434.
28. Petrov MS, Loveday BP, Pylypchuk RD, McIlroy K, Phillips AR, Windsor JA. Systematic review and metaanalysis of enteral nutrition formulations in acute pancreatitis. Br J Surg. 2009; 96:1243–1252.
29. McClave SA, Greene LM, Snider HL, et al. Comparison of the safety of early enteral vs parenteral nutrition in mild acute pancreatitis. JPEN J Parenter Enteral Nutr. 1997; 21:14–20.
30. Li J, Xue GJ, Liu YL, et al. Early oral refeeding wisdom in patients with mild acute pancreatitis. Pancreas. 2013; 42:88–91.
31. Jacobson BC, Vander Vliet MB, Hughes MD, Maurer R, McManus K, Banks PA. A prospective, randomized trial of clear liquids versus low-fat solid diet as the initial meal in mild acute pancreatitis. Clin Gastroenterol Hepatol. 2007; 5:946–951.
32. Eckerwall GE, Tingstedt BB, Bergenzaun PE, Andersson RG. Immediate oral feeding in patients with mild acute pancreatitis is safe and may accelerate recovery: a randomized clinical study. Clin Nutr. 2007; 26:758–763.
33. Francisco M, Valentín F, Cubiella J, et al. Factors associated with intolerance after refeeding in mild acute pancreatitis. Pancreas. 2012; 41:1325–1330.
34. Besselink MG, van Santvoort HC, Boermeester MA, et al. Dutch Acute Pancreatitis Study Group. Timing and impact of infections in acute pancreatitis. Br J Surg. 2009; 96:267–273.
35. Villatoro E, Mulla M, Larvin M. Antibiotic therapy for prophylaxis against infection of pancreatic necrosis in acute pancreatitis. Cochrane Database Syst Rev. 2010; (5):CD002941.
36. Wittau M, Mayer B, Scheele J, Henne-Bruns D, Dellinger EP, Isenmann R. Systematic review and metaanalysis of antibiotic prophylaxis in severe acute pancreatitis. Scand J Gastroenterol. 2011; 46:261–270.
37. Kochhar R, Ahammed SK, Chakrabarti A, et al. Prevalence and outcome of fungal infection in patients with severe acute pancreatitis. J Gastroenterol Hepatol. 2009; 24:743–747.
38. Isenmann R, Schwarz M, Rau B, Trautmann M, Schober W, Beger HG. Characteristics of infection with Candida species in patients with necrotizing pancreatitis. World J Surg. 2002; 26:372–376.
39. Wu BU, Banks PA. Clinical management of patients with acute pancreatitis. Gastroenterology. 2013; 144:1272–1281.
40. de Smet AM, Kluytmans JA, Cooper BS, et al. Decontamination of the digestive tract and oropharynx in ICU patients. N Engl J Med. 2009; 360:20–31.
41. Luiten EJ, Hop WC, Lange JF, Bruining HA. Controlled clinical trial of selective decontamination for the treatment of severe acute pancreatitis. Ann Surg. 1995; 222:57–65.
42. Sawa H, Ueda T, Takeyama Y, et al. Treatment outcome of selective digestive decontamination and enteral nutrition in patients with severe acute pancreatitis. J Hepatobiliary Pancreat Surg. 2007; 14:503–508.
43. Sun S, Yang K, He X, Tian J, Ma B, Jiang L. Probiotics in patients with severe acute pancreatitis: a metaanalysis. Langenbecks Arch Surg. 2009; 394:171–177.
44. Besselink MG, van Santvoort HC, Buskens E, et al. Dutch Acute Pancreatitis Study Group. Probiotic prophylaxis in predicted severe acute pancreatitis: a randomised, double-blind, placebo-controlled trial. Lancet. 2008; 371:651–659.
45. Wu BU, Johannes RS, Kurtz S, Banks PA. The impact of hospital-acquired infection on outcome in acute pancreatitis. Gastroenterology. 2008; 135:816–820.
46. Lee JK, Kwak KK, Park JK, et al. The efficacy of nonsurgical treatment of infected pancreatic necrosis. Pancreas. 2007; 34:399–404.
47. Donald G, Donahue T, Reber HA, Hines OJ. The evolving management of infected pancreatic necrosis. Am Surg. 2012; 78:1151–1155.
48. Freeman ML, Werner J, van Santvoort HC, et al. International Multidisciplinary Panel of Speakers and Moderators. Interventions for necrotizing pancreatitis: summary of a multidisciplinary consensus conference. Pancreas. 2012; 41:1176–1194.
49. Werner J, Feuerbach S, Uhl W, Büchler MW. Management of acute pancreatitis: from surgery to interventional intensive care. Gut. 2005; 54:426–436.
50. Mouli VP, Sreenivas V, Garg PK. Efficacy of conservative treatment, without necrosectomy, for infected pancreatic necrosis: a systematic review and metaanalysis. Gastroenterology. 2013; 144:333–340.
51. van Santvoort HC, Besselink MG, Bakker OJ, et al. Dutch Pancreatitis Study Group. A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med. 2010; 362:1491–1502.
52. van Brunschot S, van Grinsven J, Voermans RP, et al. Dutch Pancreatitis Study Group. Transluminal endoscopic step-up approach versus minimally invasive surgical step-up approach in patients with infected necrotising pancreatitis (TENSION trial): design and rationale of a randomised controlled multicenter trial [ISRCTN09186711]. BMC Gastroenterol. 2013; 13:161.
53. Bakker OJ, van Santvoort HC, van Brunschot S, et al. Dutch Pancreatitis Study Group. Endoscopic transgastric vs surgical necrosectomy for infected necrotizing pancreatitis: a randomized trial. JAMA. 2012; 307:1053–1061.
54. Raraty MG, Halloran CM, Dodd S, et al. Minimal access retroperitoneal pancreatic necrosectomy: improvement in morbidity and mortality with a less invasive approach. Ann Surg. 2010; 251:787–793.
55. Carter CR, McKay CJ, Imrie CW. Percutaneous necrosectomy and sinus tract endoscopy in the management of infected pancreatic necrosis: an initial experience. Ann Surg. 2000; 232:175–180.
56. Horvath K, Freeny P, Escallon J, et al. Safety and efficacy of video-assisted retroperitoneal debridement for infected pancreatic collections: a multicenter, prospective, single-arm phase 2 study. Arch Surg. 2010; 145:817–825.
57. van Santvoort HC, Besselink MG, Horvath KD, et al. Dutch Acute Pancreatis Study Group. Videoscopic assisted retroperitoneal debridement in infected necrotizing pancreatitis. HPB (Oxford). 2007; 9:156–159.
58. Chen H, Li F, Sun JB, Jia JG. Abdominal compartment syndrome in patients with severe acute pancreatitis in early stage. World J Gastroenterol. 2008; 14:3541–3548.
59. De Waele JJ, Leppäniemi AK. Intra-abdominal hypertension in acute pancreatitis. World J Surg. 2009; 33:1128–1133.
60. Bezmarevic M, Mirkovic D, Soldatovic I, et al. Correlation between procalcitonin and intraabdominal pressure and their role in prediction of the severity of acute pancreatitis. Pancreatology. 2012; 12:337–343.
61. Radenkovic DV, Bajec D, Ivancevic N, et al. Decompressive laparotomy with temporary abdominal closure versus percutaneous puncture with placement of abdominal catheter in patients with abdominal compartment syndrome during acute pancreatitis: background and design of multicenter, randomised, controlled study. BMC Surg. 2010; 10:22.
62. Rünzi M, Saluja A, Lerch MM, Dawra R, Nishino H, Steer ML. Early ductal decompression prevents the progression of biliary pancreatitis: an experimental study in the opossum. Gastroenterology. 1993; 105:157–164.
63. Senninger N, Moody FG, Coelho JC, Van Buren DH. The role of biliary obstruction in the pathogenesis of acute pancreatitis in the opossum. Surgery. 1986; 99:688–693.
64. Acosta JM, Pellegrini CA, Skinner DB. Etiology and pathogenesis of acute biliary pancreatitis. Surgery. 1980; 88:118–125.
65. Acosta JM, Katkhouda N, Debian KA, Groshen SG, Tsao-Wei DD, Berne TV. Early ductal decompression versus conservative management for gallstone pancreatitis with ampullary obstruction: a prospective randomized clinical trial. Ann Surg. 2006; 243:33–40.
66. Tse F, Yuan Y. Early routine endoscopic retrograde cholangiopancreatography strategy versus early conservative management strategy in acute gallstone pancreatitis. Cochrane Database Syst Rev. 2012; 5:CD009779.
67. Kiriyama S, Takada T, Strasberg SM, et al. Tokyo Guidelines Revision Committee. TG13 guidelines for diagnosis and severity grading of acute cholangitis (with videos). J Hepatobiliary Pancreat Sci. 2013; 20:24–34.
68. Oría A, Cimmino D, Ocampo C, et al. Early endoscopic intervention versus early conservative management in patients with acute gallstone pancreatitis and biliopancreatic obstruction: a randomized clinical trial. Ann Surg. 2007; 245:10–17.
69. Neoptolemos JP, Carr-Locke DL, London NJ, Bailey IA, James D, Fossard DP. Controlled trial of urgent endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy versus conservative treatment for acute pancreatitis due to gallstones. Lancet. 1988; 2:979–983.
70. Fölsch UR, Nitsche R, Lüdtke R, Hilgers RA, Creutzfeldt W. 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.
71. ISRCTN Registry; ISRCTN97372133. [Internet]. London: BioMed Central;2012. [cited 2015 Aug 13]. Available from:. http://www.isrctn.com/ISRCTN97372133.
72. Banks PA, Freeman ML. Practice Parameters Committee of the American College of Gastroenterology. Practice guidelines in acute pancreatitis. Am J Gastroenterol. 2006; 101:2379–2400.
73. Forsmark CE, Baillie J. AGA Institute technical review on acute pancreatitis. Rev Gastroenterol Mex. 2007; 72:257–285.
74. 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.
75. 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(Suppl 3):iii1–iii9.
76. van Santvoort HC, Bakker OJ, Besselink MG, et al. Dutch Pancreatitis Study Group. Prediction of common bile duct stones in the earliest stages of acute biliary pancreatitis. Endoscopy. 2011; 43:8–13.
77. Schepers NJ, Besselink MG, van Santvoort HC, Bakker OJ, Bruno MJ. Dutch Pancreatitis Study Group. Early management of acute pancreatitis. Best Pract Res Clin Gastroenterol. 2013; 27:727–743.
78. Guo J, Huang W, Yang XN, et al. Short-term continuous high-vol-ume hemofiltration on clinical outcomes of severe acute pancreatitis. Pancreas. 2014; 43:250–254.
79. Yang C, Guanghua F, Wei Z, et al. Combination of hemofiltration and peritoneal dialysis in the treatment of severe acute pancreatitis. Pancreas. 2010; 39:16–19.
80. Jiang HL, Xue WJ, Li DQ, et al. Influence of continuous veno-venous hemofiltration on the course of acute pancreatitis. World J Gastroenterol. 2005; 11:4815–4821.
81. Seta T, Noguchi Y, Shikata S, Nakayama T. Treatment of acute pancreatitis with protease inhibitors administered through intravenous infusion: an updated systematic review and metaanalysis. BMC Gastroenterol. 2014; 14:102.
82. Bi Y, Atwal T, Vege SS. Drug therapy for acute pancreatitis. Curr Treat Options Gastroenterol. 2015; 13:354–368.
83. Takeda K, Matsuno S, Sunamura M, Kakugawa Y. Continuous regional arterial infusion of protease inhibitor and antibiotics in acute necrotizing pancreatitis. Am J Surg. 1996; 171:394–398.
84. Imaizumi H, Kida M, Nishimaki H, et al. Efficacy of continuous regional arterial infusion of a protease inhibitor and antibiotic for severe acute pancreatitis in patients admitted to an intensive care unit. Pancreas. 2004; 28:369–373.
85. Ino Y, Arita Y, Akashi T, et al. Continuous regional arterial infusion therapy with gabexate mesilate for severe acute pancreatitis. World J Gastroenterol. 2008; 14:6382–6387.
86. Piaś cik M, Rydzewska G, Milewski J, et al. The results of severe acute pancreatitis treatment with continuous regional arterial infusion of protease inhibitor and antibiotic: a randomized controlled study. Pancreas. 2010; 39:863–867.
87. Hamada T, Yasunaga H, Nakai Y, et al. Continuous regional arterial infusion for acute pancreatitis: a propensity score analysis using a nationwide administrative database. Crit Care. 2013; 17:R214.
88. Du WD, Yuan ZR, Sun J, et al. Therapeutic efficacy of high-dose vitamin C on acute pancreatitis and its potential mechanisms. World J Gastroenterol. 2003; 9:2565–2569.
89. Lindner D, Lindner J, Baumann G, Dawczynski H, Bauch K. Investigation of antioxidant therapy with sodium selenite in acute pancreatitis. A prospective randomized blind trial. Med Klin (Munich). 2004; 99:708–712.
90. Siriwardena AK, Mason JM, Balachandra S, et al. Randomised, double blind, placebo controlled trial of intravenous anti-oxidant (n-acetylcysteine, selenium, vitamin C) therapy in severe acute pancreatitis. Gut. 2007; 56:1439–1444.
91. Jeurnink SM, Nijs MM, Prins HA, Greving JP, Siersema PD. Antioxidants as a treatment for acute pancreatitis: a metaanalysis. Pancreatology. 2015; 15:203–208.
92. Asrani V, Chang WK, Dong Z, Hardy G, Windsor JA, Petrov MS. Glutamine supplementation in acute pancreatitis: a metaanalysis of randomized controlled trials. Pancreatology. 2013; 13:468–474.
93. Lankisch PG, Apte M, Banks PA. Acute pancreatitis. Lancet. 2015; 386:85–96.
94. Xu W, Zhou YF, Xia SH. Octreotide for primary moderate to severe acute pancreatitis: a metaanalysis. Hepatogastroenterology. 2013; 60:1504–1508.
95. Andriulli A, Leandro G, Clemente R, et al. Meta-analysis of somatostatin, octreotide and gabexate mesilate in the therapy of acute pancreatitis. Aliment Pharmacol Ther. 1998; 12:237–245.
96. Wang R, Yang F, Wu H, et al. High-dose versus low-dose octreotide in the treatment of acute pancreatitis: a randomized controlled trial. Peptides. 2013; 40:57–64.
97. Wang G, Wen J, Wilbur RR, Wen P, Zhou SF, Xiao X. The effect of somatostatin, ulinastatin and Salvia miltiorrhiza on severe acute pancreatitis treatment. Am J Med Sci. 2013; 346:371–376.
98. Yang F, Wu H, Li Y, et al. Prevention of severe acute pancreatitis with octreotide in obese patients: a prospective multicenter randomized controlled trial. Pancreas. 2012; 41:1206–1212.
99. Ebbehøj N, Friis J, Svendsen LB, Bülow S, Madsen P. Indomethacin treatment of acute pancreatitis: a controlled double-blind trial. Scand J Gastroenterol. 1985; 20:798–800.
100. Johnson CD, Kingsnorth AN, Imrie CW, et al. Double blind, randomised, placebo controlled study of a platelet activating factor antagonist, lexipafant, in the treatment and prevention of organ failure in predicted severe acute pancreatitis. Gut. 2001; 48:62–69.
101. Kyhälä L, Mentula P, Kylänpää L, et al. Activated protein C does not alleviate the course of systemic inflammation in the APCAP trial. Int J Inflam. 2012; 2012:712739.
102. Vege SS, Atwal T, Bi Y, Chari ST, Clemens MA, Enders FT. Pentoxifylline treatment in severe acute pancreatitis: a pilot, double-blind, placebo-controlled, randomized trial. Gastroenterology. 2015; 149:318–320.
XML Download