Early antibiotic treatment is associated with a significant improvement in the prognosis of necrotizing acute pancreatitis (AP), because of a reduction in the occurrence of septic complications.

No abstract

Prr ncrc. a tic, L X w c i s (2 Ccn ter-In ternal Medicine X X I , *Em erg ency Surgery lhptrrtm e n t , Ctrrdtr rc.1 li Hosp itul, N rip1 PS , I t r t l j Summary: Our objective was to analyze conservative management in a large series of acute necrotizing pancreatitis (ANP) patients in a specialized center for pancreatic disease in the Internal Medicine and Emergency Department of a 1.500-bed hospital. One hundred ninety-nine patients with ANP w'ere considered (mean age, 55.4 t 18.2 years; biliary etiology, 60.3%'). Identification of necrotizing forms of acute pancreatitis was obtained by ultrasonography, computed tomography scan, and surgery (53 cases). Exclusion of infection of the necrosis was based on clinical findings and percutaneous aspiration with bacteriological sampling. Medical treatment was started in all cases: 37 patients required ICU treatment; 87 patients underwent early endoscopic cholangiopancreatography (ERCP). and endoscopic sphincterotomy was performed in 61 cases; and percutaneous guided aspiration of necrosis and fluid collections was performed in 78 cases and in 9 patients with acute pseudocysts. Fiftythree patients (26.6%) underwent surgery; all patients ( n = 30) with infected necrosis were in this group. One hundred forty-six patients were unoperated (73.3%J,): clinical resolution of ANP and biochemical normalization was achieved in 132 cases (66.3%') at discharge. Ultrasonographic follow-up documented morphological resolution of necrosis and fluid collections in 84 cases (57.5%) at different periods from the onset of ANP (range, 2.2-63.5 weeks); I 6 patients dropped out and seven patients are still being followed. Spontaneous regression of acute pseudocysts was observed in 59.2%; percutaneousi endoscopic aspiration was successful in 33.3%'. Mortality was Y.S%, significantly lower than the mortality observed in operated patients (28.3%; I.' = 0.002). Conservative treatment of ANP with sterile necrosis may allow healing in most cases, independent of the extent of necrosis or its association with major complications.

The aim of the present prospective study was to investigate whether endoscopic sphincterotomy may be useful in preventing recurrence of acute pancreatitis in patients with gallstones and a high anesthesiological risk of cholecystectomy. Twenty-six elderly patients with severe cardiopulmonary, hepatic, and renal diseases were considered. Endoscopic sphincterotomy was successful in 19 cases (group A: mean age, 78.4 years; range, 71-87) and failed in 7 patients (group B: mean age, 79.8 years; range 73-85). In the follow-up period biliary pain without an increase in pancreatic serum enzymes occurred in six patients in group A and in all patients in group B (p = 0.002); recurrence of acute biliary pancreatitis with a need for hospitalization occurred in one patient in group A and in four patients in group B 0, = 0.01). These results suggest that endoscopic sphincterotomy may be considered a very useful option in reducing the recurrence of acute biliary pancreatitis in elderly patients with gallstones and a high anesthesiological risk of cholecystectomy.