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2016 ; 34
(5
): 540-5
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Improving the Outcome of Acute Pancreatitis
#MMPMID27336312
Bruno MJ
Dig Dis
2016[]; 34
(5
): 540-5
PMID27336312
show ga
Acute pancreatitis (AP) is the most common indication for hospital admission and
its incidence is rising. It has a variable prognosis, which is mainly dependent
upon the development of persistent organ failure and infected necrotizing
pancreatitis. In the past few years, based on large-scale multicenter randomized
trials, some novel insights regarding clinical management have emerged. In
patients with infected pancreatic necrosis, a step-up approach of percutaneous
catheter drainage followed by necrosectomy only when the patient does not
improve, reduces new-onset organ failure and prevents the need for necrosectomy
in about a third of patients. A randomized pilot study comparing surgical to
endoscopic necrosectomy in patients with infected necrotizing pancreatitis showed
a striking reduction of the pro-inflammatory response following endoscopic
necrosectomy. These promising results have recently been tested in a large
multicenter randomized trial whose results are eagerly awaited. Contrary to
earlier data from uncontrolled studies, a large multicenter randomized trial
comparing early (within 24 h) nasoenteric tube feeding compared with an oral diet
after 72 h, did not show that early nasoenteric tube feeding was superior in
reducing the rate of infection or death in patients with AP at high risk for
complications. Although early ERCP does not have a role in the treatment of
predicted mild pancreatitis, except in the case of concomitant cholangitis, it
may ameliorate the disease course in patients with predicted severe pancreatitis.
Currently, a large-scale randomized study is underway and results are expected in
2017.
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