Diagnosis and management of acute pancreatitis and its complications

Dupuis, C; Baptista, Veronica; Whalen, Giles F.; Karam, Adib R.; Singh, Anupam; Wassef, Wahid; Kim, Young H.

doi:10.1016/j.gii.2013.03.001

Cited by 25 publications

(24 citation statements)

References 42 publications

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“…In 15-20% of cases, this may be followed by a stage of secondary bacterial infection within the inflamed pancreas, typically 2-3 weeks from the onset of pancreatitis. 13 Pathogenesis of secondary bacterial pancreatic infection is still debated. Pathogens can reach the pancreas through the haematogenous pathway, via the biliary system, ascending from the duodenum via the main pancreatic duct, or through transmural colonic migration via translocation of the colonic bacteria to the lymphatics.…”

Section: Infection In Pancreatitis: Focus On Mechanism Of Secondary Pmentioning

confidence: 99%

Prophylactic antibiotics in acute pancreatitis: endless debate

Mourad

Evans

Kalidindi

et al. 2017

annals

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INTRODUCTION The development of pancreatic infection is associated with the development of a deteriorating disease with subsequent high morbidity and mortality. There is agreement that in mild pancreatitis there is no need to use antibiotics; in severe pancreatitis it would appear to be a logical choice to use antibiotics to prevent secondary pancreatic infection and decrease associated mortality. MATERIALS AND METHODS A non-systematic review of current evidence, meta-analyses and randomized controlled trials was conducted to assess the role of prophylactic antibiotics in acute pancreatitis and whether it might improve morbidity and mortality in pancreatitis. RESULTS Mixed evidence was found to support and refute the role of prophylactic antibiotics in acute pancreatitis. Most studies have failed to demonstrate much benefit from its routine use. Data from our unit suggested little benefit of their routine use, and showed that the mortality of those treated with antibiotics was significantly higher compared with those not treated with antibiotics (9% vs 0%, respectively, P = 0.043). In addition, the antibiotic group had significantly higher morbidity (36% vs 5%, respectively, P = 0.002). CONCLUSIONS Antibiotics should be used in patients who develop sepsis, infected necrosis-related systemic inflammatory response syndrome, multiple organ dysfunction syndrome or pancreatic and extra-pancreatic infection. Despite the many other factors that should be considered, prompt antibiotic therapy is recommended once inflammatory markers are raised, to prevent secondary pancreatic infection. Unfortunately, there remain many unanswered questions regarding the indications for antibiotic administration and the patients who benefit from antibiotic treatment in acute pancreatitis.

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Section: Infection In Pancreatitis: Focus On Mechanism Of Secondary Pmentioning

confidence: 99%

Prophylactic antibiotics in acute pancreatitis: endless debate

Mourad

Evans

Kalidindi

et al. 2017

annals

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“…The dilatation process will further be performed either with dilator or 5 or 6-fr cystotome to make a larger fistula. Finally, the stent is inserted through the fistula track (plastic or metallic stent) [23][24][25][26].…”

Section: Endoscopic Ultrasound-guided Pancreatic Fluid Collection Dramentioning

confidence: 99%

Endoscopic Management of Pancreatic Fluid Collection in Acute Pancreatitis

Lesmana¹,

Lesmana²,

Ho³

2019

Pancreatitis

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Acute pancreatitis is an acute clinical condition where it can be manifested as mild disease or serious and life-threatening condition. There are several factors that may be responsible for this condition, such as genetic, gallstone disease, alcohol consumption, pancreatic trauma, medication, hypertriglyceridemia, autoimmune disease, and surgery. The most common manifestation of pancreatic parenchymal injury is pancreatic pseudocyst (PPC) formation, where peripancreatic fluid collection (PFCs) usually precedes this condition. Even though most of the pseudocyst can be managed conservatively, however in conditions such as infected pseudocyst or possible wall of necrosis (WON), there should be an early intervention management. Clinical evaluation and imaging studies have to be done in the beginning. Computed tomography (CT) scan or magnetic resonance imaging (MRI) are the main imaging techniques used to evaluate the characteristic of the cyst, the size, surrounding vascularity, and to assess the pancreatic duct itself with possible of fistula formation. Clinical conditions that are usually considered for early intervention management are symptomatic pseudocyst, large size of pseudocyst, presence of gastric outlet obstruction, or biliary obstruction. PFC should be evaluated as it has been classified based on type of pancreatitis, time frame, well-defined wall, and debris contained inside the cyst. Endoscopic management has replaced percutaneous and surgical approach in most of PFC cases. Nowadays, endoscopic ultrasound (EUS) has been widely used as the first-line tool for PFC drainage procedure. Pancreatic pseudocyst stenting is the most common procedure in most of the centers in the world. However, the cost, availability, and expertise are needed to be considered in clinical practice.

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“…In a variable percentage of patients, around 15% to 20% (Dupuis et al, 2013), complications develop that can significantly overshadow the prognosis of acute pancreatitis (Banks et al, 2012). Reasons for this disparate evolution are not fully known and are surely multifactorial (Yang, Chen, Phillips, Windsor and Petrov, 2014).…”

Section: Theoretical Frameworkmentioning

confidence: 99%