Treatment in acute pancreatitis

Year 2010, Volume: 18 Issue: 3, 81 - 86, 01.12.2010

Selçuk Dişibeyaz

https://doi.org/10.17940/endoskopi.74892

Abstract

The prevalence of acute pancreatitis in population is estimated as 100.000/520 and alcohol and bile stone migration are considered as causes in 80% of cases. Disease has a mild course in most cases and patients recover with a short term hospitalization. In minority of patients, disease has a severe course that may cause death eventually. Patients in last form should be treated in ICU and be monitored very closely. Therefore estimating the severity of the disease early in the course, using several severity indexes which is developed for this purpose is very important. The treatment includes medical and interventional (surgical / endoscopic) modalities. Fluid replacement, pain control, antibiotic prophylaxis , enteral feeding, thrombosis prophlaxis and O2 support are considered as essentials of medical treatment. Invasive methods are consist of biliary stone extraction , stenting in pancreas divisium, sphincterotomy in Sphyncter of Oddi Dysfunction via endoscopic retrograde cholangiopancreatography and endoscopic or surgical debridman in pancreatic necrosis and pseudocyst drainage.

Keywords

Acute, pancreatitis, treatment

Akut pankreatitde tedavi

Abstract

Toplumdaki insidansı 100.000'de 5-20 olan akut pankreatitin en sık nedeni %80 olguda alkol ve safra taşı migrasyonudur. Olguların büyük çoğunluğu hafif formda olup, sadece kısa süreli hospitalizasyonla düzelebilirken, az bir kısmı ciddi mortalitiye de neden olabilen şiddetli formda görülür. Şiddetli formlarda tedavi mutlak yoğun bakım koşullarında yapılmalı ve hasta çok yakından izlenmelidir. Bu nedenle bu amaçla geliştirilmiş indeksler kullanılarak şiddetli formun önceden tanınması çok önemlidir. Tedavi medikal ve girişimsel (endoskopik/cerrahi) olmak üzere ikiye ayrılabilir. Sıvı replasmanı, ağrı kontrolü, tromboz proflaksisi, antibiyotik proflaksisi, enteral beslenme, O2 tedavisi medikal tedavide önemliyken, endoskopik retrograd kolanjiyopankreatografi ile biliyer pankreatitde taş ekstraksiyonu, pankreas divisumda stent yerleştirilmesi, sfinkter oddi disfonksiyonunda sfinkterotomi ve ayrıca endoskopik/cerrahi nekroz debridmanı, pseudokist drenajı uygulanabilecek girişimsel yöntemlerdir.

Keywords

Akut, pankreatit, tedavi

References

• Halangk W, Lerch MM. Early events in acute pancreatitis. Gastroenterol Clin N Am 2004; 33: 717-31.
• Guzman EA, Rudnicki M. Intricacies of host response in acute pancreati- tis. J Am Coll Surg 2006; 202: 509-19.
• Yadav D, Lowenfels AB. Trends in the epidemiology of the first attack of acute pancreatitis: a systematic review. Pancreas 2006; 33: 323-30.
• Van Westerloo DJ, Bruno MJ, van der Poll T. New insights into the pat- hophysiology and severity assessment of acute pancreatitis. In: Vincent JL (ed.), Yearbook of Intensive Care and Emergency Medicine. Berlin Springer; 2003; 823-87.
• Marx C. Adrenocortical insuffi ency: An early step in the pathogenesis of severe acute pancreatitis and development of necrosis? Do we have a new treatment option? Crit Care Med 2006; 34: 1269-70.
• Owyang C. Pancreatitis. In: Goldman L (ed.), Cecil Medicine, 23rd ed. Saunders, An Imprint of Elsevier, 2007. Accessed through www.mdcon- sult.com
• Carroll JK, Herrick B, Gipson T, Lee SP. Acute pancreatitis: Diagnosis, prognosis, and treatment. Am Fam Physician 2007; 75: 1513-20.
• Go VLW, DiMagno EP, Gardner JD et al. The pancreas: biology, patho- biology, and disease. 2nded. New York, Raven Press, 1993.
• Elfar M, Gaber LW, Sabek O, et al. The inflammatory cascade in acute pancreatitis: relevance to clinical disease. Surg Clin North Am 2007; 87: 1325-40, vii.
• Balthazar EJ, Robinson DL, Megibow AJ, Ranson JH. Acute pancreatitis: value of CT in establishing prognosis. Radiology 1990; 174: 331-6.
• Chatzicostas C, Roussomoustakaki M, Vardas E, et al. Balthazar compu- ted tomography severity index is superior to Ranson criteria and APAC- HE II and III scoring systems in predicting acute pancreatitis outcome. J Gastroenterol 2003; 36: 253-60.
• Balthazar EJ. Complications of acute pancreatitis: Clinical and CT evalu- ation. Radiol Clin North Am 2002; 40: 1211-27.
• Beger HG, Rau B, Mayer J, Pralle U. Natural course of acute pancreatitis. World J Surg 1997; 21: 130-5.
• Law NM, Freeman ML. Emergency complications of acute and chronic pancreatitis. Gastroenterol Clin North Am 2003; 32: 1169-94, ix.
• Mayerle J, Simon P, Lerch MM. Medical treatment of acute pancreatitis. Gastroenterol Clin North Am 2004; 33: 855-69, viii.
• Sax HC, Warner BW, Talamini MA, et al. Early total parenteral nutrition in acute pancreatitis: lack of beneficial effects. Am J Surg 1987; 153: 117-24.
• Marik PE, Zaloga GP. Meta-analysis of parenteral nutrition versus ente- ral nutrition in patients with acute pancreatitis. BMJ 2004; 328: 1407.
• Heyland DK, Drover JW, MacDonald S, et al. Effect of postpyloric fee- ding on gastroesophageal regurgitation and pulmonary microaspiration: results of a randomized controlled trial. Crit Care Med 2001; 29: 1495- 501.
• Tenner S: Initial management of acute pancreatitis: critical issues during the first 72 hours. Am J Gastroenterol 2004; 99: 2489-94.
• McClave SA, Chang WK, Dhaliwal R, Heyland DK. Nutrition support in acute pancreatitis: a systematic review of the literature. JPEN J Parenter Enteral Nutr 2006; 30: 143-56.
• Thompson DR. Narcotic analgesic effects on the sphincter of Oddi: a re- view of the data and therapeutic implications in treating pancreatitis. Am J Gastroenterol 2001; 96: 1266-72.
• Bernhardt A, Kortgen A, Niesel HCh, Goertz A. Using epidural anesthe- sia in patients with acute pancreatitis–prospective study of 121 patients. Anaesthesiol Reanim 2002; 27: 16-22.
• Sharma VK, Howden CW. Prophylactic antibiotic administration redu- ces sepsis and mortality in acute necrotizing pancreatitis: a meta-analy- sis. Pancreas 2001; 22: 28-31.
• Howard TJ, Temple MB. Prophylactic antibiotics alter the bacteriology of infected necrosis in severe acute pancreatitis. J Am Coll Surg 2002; 195: 759-67.
• Isenmann R, Runzi M, Kron M, et al. Prophylactic antibiotic treatment in patients with predicted severe acute pancreatitis: A placebo-controlled, double-blind trial. Gastroenterology 2004; 126: 997-1004.
• Pederzoli P, Bassi C, Vesentini S, Campedelli A. A randomized multicen- ter trial of antibiotic prophylaxis of septic complications in acute necro- tizing pancreatitis with imipenem. Surg Gynecol Obstet 1993; 176: 480- 3.
• Bassi C, Larvin M, Villatoro E. Antibiotic therapy for prophylaxis against infection of pancreatic necrosis in acute pancreatitis. Cochrane Database Syst Rev, 2003; (4): CD002941.
• Finley JW. Respiratory complications of acute pancreatitis. Am Surg 1969; 35: 591-8.
• Pastor CM, Matthay MA, Frossard JL. Pancreatitis-associated acute lung injury: New insights. Chest 2003; 124: 2341-51.
• Carroll JK, Herrick B, Gipson T, Lee SP. Acute pancreatitis: Diagnosis, prognosis, and treatment. Am Fam Physician 2007; 75: 1513-20.
• Malangoni MA, Martin AS. Outcome of severe acute pancreatitis. Am J Surg 2005; 189: 273-7.
• Attasaranya S, Abdel Aziz AM, Lehman GA. Endoscopic management of acute and chronic pancreatitis. Surg Clin North Am 2007; 87: 1379-402, viii.
• Hookey LC, Debroux S, Delhaye M, et al. Endoscopic drainage of pan- creatic fluid collections in 116 patients: a comparison of etiologies, dra- inage techniques and outcomes. Gastrointest Endosc 2006; 63: 635-43.
• Sriram PV, Kaffes AJ, Rao GV, Reddy DN. Endoscopic ultrasound-gui- ded drainage of pancreatic pseudocysts complicated by portal hyperten- sion or by intervening vessels. Endoscopy 2005; 37: 231-5.
• Somogyi L, Chuttani R, Croffie J, et al. Biliary and pancreatic stents. Gas- trointest Endosc 2006; 63: 910-9.
• Singh P, Das A, Isenberg G, et al. Does prophylactic pancreatic stent pla- cement reduce the risk of post-ERCP acute pancreatitis? A meta-analysis of controlled trials. Gastrointest Endosc 2004; 60: 544-50.
• Oría A, Cimmino D, Ocampo C, et al. Early endoscopic intervention ver- sus early conservative management in patients with acute gallstone pan- creatitis and biliopancreatic obstruction: a randomized clinical trial. Ann Surg 2007; 245: 10-7.
• Fölsch UR, Nitsche R, Lüdtke R, et al. Early ERCP and papillotomy compared with conservative treatment for acute biliary pancreatitis. The German Study Group on Acute Biliary Pancreatitis. N Engl J Med 1997; 336: 237-42.
• Neoptolemos JP, Carr-Locke DL, London NJ, et al. Controlled trial of ur- gent endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy versus conservative treatment for acute pancreatitis due to gallstones. Lancet 1988; 2: 979-83.
• Sharma VK, Howden CW. Metaanalysis of randomized controlled trials of endoscopic retrograde cholangiography and endoscopic sphinctero- tomy for the treatment of acute biliary pancreatitis. Am J Gastroenterol 1999; 94: 3211-4.
• Petrov MS, van Santvoort HC, Besselink MG, et al. Early endoscopic ret- rograde cholangiopancreatography versus conservative management in acute biliary pancreatitis without cholangitis: a meta-analysis of rando- mized trials. Ann Surg 2008; 247: 250-7.
• Forsmark CE, Baillie J; AGA Institute Clinical Practice and Economics Committee; AGA Institute Governing Board. AGA Institute technical re- view on acute pancreatitis. Gastroenterology 2007; 132: 2022-44.
• Taylor E, Wong C. The optimal timing of laparoscopic cholecystectomy in mild gallstone pancreatitis. Am Surg 2004; 70: 971-5.