Early Management of Severe Acute Pancreatitis

Significant literature on the management of acute severe acute pancreatitis has emerged in recent years. The new information ranges from data on newer single or multiparameter severity assessment tools and classification systems to therapeutic modalities. However, a few basic issues—the ideal severity assessment modality, volume of intravenous fluids required in the first 48 to 72 h, and the role of prophylactic antibiotics—are still not clear and are subject to controversy. The International Working Group has devised the Revised Atlanta Classification, which will be published soon. This new classification is eagerly awaited worldwide, and hopefully clarifies many of the problems of the original Atlanta Classification. In this article, we discuss the developments that have arisen in the past 2 to 3 years concerning the classification, prognostication, and early management of severe acute pancreatitis.

[1]  R. Talukdar,et al.  Recent developments in acute pancreatitis. , 2009, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[2]  H. Gooszen,et al.  Early Endoscopic Retrograde Cholangiopancreatography Versus Conservative Management in Acute Biliary Pancreatitis Without Cholangitis: A Meta-Analysis of Randomized Trials , 2008, Annals of surgery.

[3]  Toyia N. James-Stevenson,et al.  The Panc 3 Score: A Rapid and Accurate Test for Predicting Severity on Presentation in Acute Pancreatitis , 2007, Journal of clinical gastroenterology.

[4]  C. Cavicchioni,et al.  Intra‐abdominal vacuum‐assisted closure (VAC) after necrosectomy for acute necrotising pancreatitis: preliminary experience , 2010, International wound journal.

[5]  Vikesh K. Singh,et al.  A Prospective Evaluation of the Bedside Index for Severity in Acute Pancreatitis Score in Assessing Mortality and Intermediate Markers of Severity in Acute Pancreatitis , 2009 .

[6]  R. Parks,et al.  Association between early systemic inflammatory response, severity of multiorgan dysfunction and death in acute pancreatitis , 2006, The British journal of surgery.

[7]  P. Garg,et al.  Characterization of Newer Subgroups of Fulminant and Subfulminant Pancreatitis Associated With a High Early Mortality , 2007, The American Journal of Gastroenterology.

[8]  V. Pettilä,et al.  APCAP - activated protein C in acute pancreatitis: a double-blind randomized human pilot trial , 2010, Critical care.

[9]  M. Boermeester,et al.  Probiotic prophylaxis in predicted severe acute pancreatitis: a randomised, double-blind, placebo-controlled trial , 2008, The Lancet.

[10]  Bechien U. Wu,et al.  Early changes in blood urea nitrogen predict mortality in acute pancreatitis. , 2009, Gastroenterology.

[11]  N. Takahashi,et al.  CT findings of walled-off pancreatic necrosis (WOPN): differentiation from pseudocyst and prediction of outcome after endoscopic therapy , 2008, European Radiology.

[12]  B. Petersen,et al.  Outcomes of Intra-Abdominal Fungal vs. Bacterial Infections in Severe Acute Pancreatitis , 2009, The American Journal of Gastroenterology.

[13]  C. Bassi,et al.  Antibiotic therapy for prophylaxis against infection of pancreatic necrosis in acute pancreatitis. , 2010, The Cochrane database of systematic reviews.

[14]  Sheng-dao Zhang,et al.  Rapid hemodilution is associated with increased sepsis and mortality among patients with severe acute pancreatitis. , 2010, Chinese medical journal.

[15]  B. Petersen,et al.  Low Mortality and High Morbidity in Severe Acute Pancreatitis Without Organ Failure: A Case for Revising the Atlanta Classification to Include “Moderately Severe Acute Pancreatitis” , 2009, The American Journal of Gastroenterology.

[16]  E L Bradley,et al.  A clinically based classification system for acute pancreatitis. Summary of the International Symposium on Acute Pancreatitis, Atlanta, Ga, September 11 through 13, 1992. , 1993, Archives of surgery.

[17]  J. Fletcher,et al.  Peripancreatic collections in acute pancreatitis: correlation between computerized tomography and operative findings. , 2010, World journal of gastroenterology.

[18]  Tobias Keck,et al.  Elevated blood urea nitrogen is an independent risk factor of prolonged intensive care unit stay due to acute necrotizing pancreatitis. , 2010, Journal of critical care.

[19]  P. Banks,et al.  Hemoconcentration Is an Early Marker for Organ Failure and Necrotizing Pancreatitis , 2000, Pancreas.

[20]  M. Boermeester,et al.  Intestinal Barrier Dysfunction in a Randomized Trial of a Specific Probiotic Composition in Acute Pancreatitis , 2009, Annals of surgery.

[21]  Michael R. O'Connell,et al.  Comparison of BISAP, Ranson's, APACHE-II, and CTSI Scores in Predicting Organ Failure, Complications, and Mortality in Acute Pancreatitis , 2010, The American Journal of Gastroenterology.

[22]  Heikki Repo,et al.  Inflammation and immunosuppression in severe acute pancreatitis. , 2010, World journal of gastroenterology.

[23]  B. Petersen,et al.  Faster Rate of Initial Fluid Resuscitation in Severe Acute Pancreatitis Diminishes In-Hospital Mortality , 2010, Pancreatology.

[24]  D. Lobo,et al.  ESPEN Guidelines on Parenteral Nutrition: pancreas. , 2006, Clinical nutrition.

[25]  R. Talukdar,et al.  Role of endoscopic ultrasound during hospitalization for acute pancreatitis. , 2010, World journal of gastroenterology.

[26]  Bechien U. Wu,et al.  Early Hemoconcentration Predicts Increased Mortality Only among Transferred Patients with Acute Pancreatitis , 2009, Pancreatology.

[27]  A. Leppäniemi,et al.  Intra-Abdominal Hypertension in Acute Pancreatitis , 2009, World Journal of Surgery.

[28]  T. Baron,et al.  Minimally Invasive Techniques in Pancreatic Necrosis , 2009, Pancreas.

[29]  J. Windsor,et al.  Systematic review and meta‐analysis of enteral nutrition formulations in acute pancreatitis , 2009, The British journal of surgery.

[30]  P. Maisonneuve,et al.  The harmless acute pancreatitis score: a clinical algorithm for rapid initial stratification of nonsevere disease. , 2009, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[31]  S. Chari,et al.  Organ failure as an indicator of severity of acute pancreatitis: time to revisit the Atlanta classification. , 2005, Gastroenterology.

[32]  A. Sijacki,et al.  SIRS score on admission and initial concentration of IL-6 as severe acute pancreatitis outcome predictors. , 2010, Hepato-gastroenterology.

[33]  E. J. van der Jagt,et al.  Describing Computed Tomography Findings in Acute Necrotizing Pancreatitis With the Atlanta Classification: An Interobserver Agreement Study , 2006, Pancreas.

[34]  S. Chari,et al.  T1302 Moderately Severe Acute Pancreatitis: A Prospective Validation Study of This New Subgroup of Acute Pancreatitis , 2009 .

[35]  Bradley El rd,et al.  A clinically based classification system for acute pancreatitis. , 1993 .

[36]  K. Horvath,et al.  The Atlanta Classification of acute pancreatitis revisited , 2007, The British journal of surgery.

[37]  T. Baron,et al.  Pancreatic fluid collections prior to intervention: evaluation with MR imaging compared with CT and US. , 1997, Radiology.

[38]  M. Boermeester,et al.  Describing Peripancreatic Collections in Severe Acute Pancreatitis Using Morphologic Terms: An International Interobserver Agreement Study , 2008, Pancreatology (Print).

[39]  Y. Ku,et al.  Utility of the new Japanese severity score and indications for special therapies in acute pancreatitis , 2009, Journal of Gastroenterology.

[40]  J. Windsor,et al.  Classification of the Severity of Acute Pancreatitis: How Many Categories Make Sense? , 2010, The American Journal of Gastroenterology.

[41]  C. Johnson,et al.  Painful ascites , 2004, Gut.

[42]  P. Banks,et al.  Practice Guidelines in Acute Pancreatitis , 2006, The American Journal of Gastroenterology.

[43]  S. Evans,et al.  Dynamic nature of early organ dysfunction determines outcome in acute pancreatitis , 2002, The British journal of surgery.

[44]  K. Madan,et al.  Primary conservative treatment results in mortality comparable to surgery in patients with infected pancreatic necrosis. , 2010, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[45]  P. Malfertheiner,et al.  Human pancreatic tissue concentration of bactericidal antibiotics. , 1992, Gastroenterology.

[46]  J. Windsor,et al.  Organ failure and infection of pancreatic necrosis as determinants of mortality in patients with acute pancreatitis. , 2010, Gastroenterology.

[47]  Vikesh K. Singh,et al.  Early systemic inflammatory response syndrome is associated with severe acute pancreatitis. , 2009, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[48]  Bechien U. Wu,et al.  The early prediction of mortality in acute pancreatitis: a large population-based study , 2008, Gut.

[49]  B. Rau.  Predicting severity of acute pancreatitis , 2007, Current gastroenterology reports.

[50]  B. Rau,et al.  Early Severe Acute Pancreatitis: Characteristics of a New Subgroup , 2001, Pancreas.

[51]  V. Muddana,et al.  Elevated Serum Creatinine as a Marker of Pancreatic Necrosis in Acute Pancreatitis , 2008, The American Journal of Gastroenterology.

[52]  B. Petersen,et al.  A comparison of direct endoscopic necrosectomy with transmural endoscopic drainage for the treatment of walled-off pancreatic necrosis. , 2009, Gastrointestinal endoscopy.