Management of acute pancreatitis

Abstract

Acute pancreatitis (AP) is a common medical condition with extensive morbidity and mortality. Approximately 210,000 Americans are hospitalized each year; and 5% of patients with AP will die. It is also an expensive condition, costing 2.6 billion dollars (United States) in 2009 alone. Moreover, the incidence is increasing – the National Hospital Discharge Survey showed hospitalizations increased from 78 per 100,000 in 2007 to 90 per 100,000 just three years later in 2010. There is no proven pharmacologic entity to treat the inflammatory response associated with acute pancreatitis; supportive care with IV fluids, bowel rest and pain control are the mainstays of therapy. Recently, new developments to help increase survival and minimize morbidity with several key interventions have been investigated. This summary highlights new studies and meta-analyses to provide current opinion on treatment of this morbid condition.

Keywords::

• acute pancreatitis
• direct endoscopic necrosectomy
• ERCP
• fluid resuscitation
• management
• VARD

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Generous IV fluid administration in the first 24 h is the most crucial intervention to prevent morbidity and mortality.

• Aggressive work-up to determine the cause of pancreatitis is indicated to prevent further attacks.

• Prophylactic antibiotics have not been shown to prevent morbidity or mortality, even in severe necrotizing pancreatitis.

• Prediction of severity using the bedside index for severity of acute pancreatitis is the preferred technique because of its comparative effectiveness and superior ease of use.

• Antibiotics should be given with any documentation of infection and then tailored to cultures based on computed tomography-drainage.

• In biliary pancreatitis, cholecystectomy should be performed prior to discharge.

• Minimally invasive surgical approaches, such as direct endoscopic necrosectomy, are preferred to treat walled-off necrosis.