Endoscopic Treatment of Recurrent Acute Pancreatitis and Smoldering Acute Pancreatitis

Das, Rohit; Yadav, Dhiraj; Papachristou, Georgios I.

doi:10.1016/j.giec.2015.06.008

Cited by 14 publications

(5 citation statements)

References 42 publications

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“…However the role of pancreas divisum remains as an etiology of AP is controversial[9,47]. Pancreas divisum is a common variant seen in up to 14% of patients[48-50]. The clinical implica-tions remain controversial and currently there is no consensus if pancreatic divisum alone can cause AP[9,47,51].…”

Section: Etiologymentioning

confidence: 99%

Evaluation and management of acute pancreatitis

Chatila

Bilal

Guturu

2019

WJCC

114

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Acute pancreatitis (AP) is one of the most common gastrointestinal causes for hospi-talization in the United States. In 2015, AP accounted for approximately 390000 hospitalizations. The burden of AP is only expected to increase over time. Despite recent advances in medicine, pancreatitis continues to be associated with a substantial morbidity and mortality. The most common cause of AP is gallstones, followed closely by alcohol use. The diagnosis of pancreatitis is established with any two of three following criteria: (1) Abdominal pain consistent with that of AP; (2) Serum amylase and/or lipase greater than three times the upper limit of normal; and (3) Characteristics findings seen in cross-sectional abdominal imaging. Multiple criteria and scoring systems have been established for assessing severity of AP. The cornerstones of management include aggressive intravenous hydration, appropriate nutrition and pain management. Endoscopic retrograde cholangiopancreatography and surgery are important aspects in management of acute gallstone pancreatitis. We provide a comprehensive review of evaluation and management of AP.

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Section: Etiologymentioning

confidence: 99%

Evaluation and management of acute pancreatitis

Chatila

Bilal

Guturu

2019

WJCC

114

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“…The response to pancreatic sphincterotomy or stent placement have been variably reported in 50%-100% of patients with idiopathic RAP irrespective of whether they had SOD or not in various case series[4,5,28]. In a recent randomised trial, combined pancreatic and biliary sphincterotomy was no better than biliary sphincterotomy alone in patients with RAP and SOD, either treatment relieving pain in about half the patients[16].…”

Section: Discussionmentioning

confidence: 99%

Continuing episodes of pain in recurrent acute pancreatitis: Prospective follow up on a standardised protocol with drugs and pancreatic endotherapy

Pai

Kamath

Shetty

et al. 2017

WJG

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AIMTo assess the outcomes of drug therapy (DT) followed by pancreatic endotherapy for continuing painful episodes in recurrent acute pancreatitis.METHODSDT comprised of pancreatic enzymes and anti-oxidants failing which, endotherapy (ET; pancreatic sphincterotomy and stent placement) was done. The frequency of pain, its visual analogue score (VAS), quality of life (QoL), serum C peptide and faecal elastase were compared between baseline and after 1 year of follow up in all patients and in the two subgroups on DT and ET. Response was defined as at least 50% reduction in the severity of pain to below a score of 5.RESULTSOf the thirty nine patients analysed, 21 (53.9%) responded to DT and 18 (46.1%) underwent ET. The VAS for pain (7.0 ± 2.0 vs 1.3 ± 2.5, P < 0.001) and the number of days with pain per month decreased [1.0 (1.0, 2.0) vs 1.0 (0.0, 1.0), P < 0.001], and the QoL scores [55.0 (44.0, 66.0) vs 38.0 (32.00, 51.00), P < 0.01] improved significantly during follow up. Similar significant improvements were seen in patients in the subgroups of DT and ET except for QoL in ET. The serum C-peptide (P = 0.001) and FE (P < 0.001) levels improved significantly in the entire group and in the two subgroups of patients except for the C peptide levels in patients on DT.CONCLUSIONA standardised protocol of DT, followed by ET decreased the intensity and frequency of pain in recurrent acute pancreatitis, enhanced QoL and improved pancreatic function.

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“…Recurrent acute pancreatitis (RAP) is generally defined as the presence of two or more episodes of AP without concomitant clinical and/or radiographic evidence of chronic pancre-atitis. 1 The estimated incidence of AP is between 15 and 45 per 100,000 persons per year, with a risk of recurrence of nearly 20%. [1][2][3][4][5][6] While gallstone diseases and alcohol exposure are generally accepted as the two primary causes of RAP, other etiologies, including autoimmune, hereditary, metabolic, and anatomic variants and Sphincter of Oddi dysfunction (SOD), are also considered.…”

Section: Introductionmentioning

confidence: 99%

Practice Patterns and Use of Endoscopic Retrograde Cholangiopancreatography in the Management of Recurrent Acute Pancreatitis

et al. 2020

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Background/Aims: There are conflicting opinions regarding the management of recurrent acute pancreatitis (RAP). While some physicians recommend endoscopic retrograde cholangiopancreatography (ERCP) in this setting, others consider it to be contraindicated in patients with RAP. The aim of this study was to assess the practice patterns and clinical features influencing the management of RAP in the US. Methods: An anonymous 35-question survey instrument was developed and refined through multiple iterations, and its use was approved by our Institutional Review Board. The survey was distributed via email to 408 gastroenterologists to assess the practice patterns in the management of RAP in multiple clinical scenarios. Results: The survey was completed by 65 participants representing 36 of the top academic/tertiary care centers across the country. Approximately 90.8% of the participants indicated that they might offer or recommend ERCP in the management of RAP. Multinomial logistic regression analysis revealed that ductal dilatation and presence of symptoms were the most predictive variables (p<0.001) for offering ERCP. Conclusions: A preponderance of the respondents would consider ERCP among patients with RAP presenting to tertiary care centers in the US. Ductal dilatation, presence of symptoms, and pancreas divisum significantly increased the likelihood of a recommendation for ERCP.

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Endoscopic Treatment of Recurrent Acute Pancreatitis and Smoldering Acute Pancreatitis

Cited by 14 publications

References 42 publications

Evaluation and management of acute pancreatitis

Evaluation and management of acute pancreatitis

Continuing episodes of pain in recurrent acute pancreatitis: Prospective follow up on a standardised protocol with drugs and pancreatic endotherapy

Practice Patterns and Use of Endoscopic Retrograde Cholangiopancreatography in the Management of Recurrent Acute Pancreatitis

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