American Gastroenterological Association Clinical Practice Update: Management of Pancreatic Necrosis

Baron, Todd H.; DiMaio, Christopher J.; Wang, Andrew Y.; Morgan, Katherine A.

doi:10.1053/j.gastro.2019.07.064

Cited by 440 publications

(477 citation statements)

References 43 publications

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“…Management guidelines of AP suggest that early initiation of fluids and enteral nutrition are the key elements in improving outcomes of these patients. 1,3,4,11 Early fluid resuscitation helps in attenuating inflammatory response and limiting the extent of necrosis which in turn could improve outcomes. 4,12 Fischer et al 13 showed that delayed resuscitation was associated with higher mortality and a trend towards greater persistent organ failure compared to early resuscitation.…”

Section: Discussionmentioning

confidence: 99%

“…15 Hence various guidelines highlight the role of starting early enteral nutrition irrespective of the severity of AP. 1,4,11,16,17 Zou et al showed that AP patients receiving early enteral nutrition had significantly lower rates of pancreatic infection and lower median hospital stays. 18 Various studies in the past have noted that the rates of infected necrosis increase beyond the first week of illness.…”

Section: Discussionmentioning

confidence: 99%

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Delayed referral increases the need for surgery and intervention in patients with acute pancreatitis

Muktesh

Samanta

Singh

et al. 2020

ANZ Journal of Surgery

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Background: The aim was to study the outcomes of acute pancreatitis (AP) patients who were referred from other facilities to a tertiary care centre. Methods: Patients with AP were who were referred from other hospitals to a tertiary care centre between April 2013 and September 2019 were studied and their outcomes were analysed. Comparison was made between patients referred early (≤7 days) versus those referred late (>7 days). Results: Of the 838 patients seen by us, 650 patients (77.6%) were referred from other centres. Median (interquartile range) onset to admission interval was 5 (4-7) days for those who were referred ≤7 days and was 16 (11-30) for those who were referred >7 days. Patients referred beyond 7 days of pain onset had higher rates of development of organ failure (P = 0.007), including acute lung injury (P = 0.008) and acute kidney injury (P = 0.026), infected necrosis (P < 0.0001), requirement of endoscopic/percutaneous drainage (P < 0.001) and need for surgery (P < 0.02) compared to patients who were referred ≤7 days of pain onset. Mortality was however similar in the two groups. Conclusion: Patients with AP referred to a specialized centre with AP early (≤7 days) have better outcomes than those referred late (>7 days) from other facilities.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Delayed referral increases the need for surgery and intervention in patients with acute pancreatitis

Muktesh

Samanta

Singh

et al. 2020

ANZ Journal of Surgery

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“…27 Carbapenems possess the broadest spectrum of antimicrobial activity, and often reserved for the most severe infections and used as ultimum refugium agents. The common indications for treatment with a carbapenem (imipenem or meropenem) are urinary infections resistant to other antibiotics, treatment of necrotizing pancreatitis 28 , treatment of severe nosocomial infections including hospital-acquired pneumonia, intraabdominal infections, bacterial soft-tissue infections, febrile neutropenia. Tigecycline, a recently developed third-generation tetracycline antibiotic belonging to the glycylcycline class is one of the few therapeutic options for treating infections caused by A. baumannii and most carbapenem-resistant bacteria.…”

Section: Discussionmentioning

confidence: 99%

A glimpse of antimicrobial resistance gene diversity in kefir and yoghurt

Tóth

Csabai

Maróti

et al. 2020

Preprint

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Antimicrobial resistance (AMR) is a global threat gaining more and more practical significance every year. The protection of bacteria against antimicrobials based on antimicrobial resistance genes (ARGs) developed in evolution. One of the essential clinical questions is the origin of ARGs of pathogen bacteria. Since the bacteria can share genetic components by horizontal gene transfer (HGT), all even non-pathogen bacteria may provide ARG to any pathogens when they became close physically. The bacteria of the human gut may make contact with bacteria entered into the body by food. The fermented food contains bacteria in high amount by its nature. Here we studied the diversity of ARG content by a unified metagenomic approach in various kefir and yoghurt products, in grain and isolated bacterial strains. We found numerous ARGs of commonly used fermenting bacteria with diversity characteristics in kefir and yoghurt samples. Even with the strictest filter restrictions we identified ARGs undermining the efficacy of aminocoumarin, aminoglycoside, carbapenem, cephalosporin, cephamycin, diaminopyrimidine, elfamycin, fluoroquinolone, fosfomycin, glycylcycline, lincosamides, macrolide, monobactam, nitrofuran, nitroimidazole, penam, penem, peptide, phenicol, rifamycin, tetracycline and triclosan. In the case of gene lmrD, we detected genetic environment providing mobility of this ARG. Our findings support that theory during the fermentation process the food ARG content can grow by the bacteria multiplication. Results presented suggest that starting culture strains of fermented food should be monitored and selected to decrease the ARG amount intake by nutrition.

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“…Endoscopic necrosectomy essentially comprises of endoscopic debridement of necrotic debris within the cyst cavity using a variety of methods including DEN and naso-cystic lavage with saline and or diluted hydrogen peroxide (3%, 1:10 dilution). DEN involves the passage of endoscope within the cyst cavity followed by mechanical removal of necrotic tissue using forceps, polypectomy snares, and retrieval nets [38]. With the availability of LCMS (≥15 mm), multiple sessions of DEN can be performed with relative ease.…”

Section: Endoscopic Necrosectomymentioning

confidence: 99%

Endoscopic Management of Pancreatic Fluid Collections: An Update

Nabi¹,

Reddy²

2019

Pancreatitis

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Pancreatic fluid collections (PFCs) are a frequent complication of acute pancreatitis. PFCs have been categorized according to their content and duration after an episode of pancreatitis. Acute collections (<4 week) and asymptomatic late collections (>4 weeks) can be usually managed conservatively. Late collections including walled off necrosis (WON) and pancreatic pseudocysts (PP) have a well-defined wall. Consequently, it is easier and safer to drain these collections when required. The most common indication to drain PFCs is infection and the available means of drainage include surgical, endoscopic, and percutaneous. Open surgical interventions carry a high risk of morbidity and mortality. Therefore, in the current era, a step up approach is preferred to minimize morbidity over the more aggressive surgical treatments. Endoscopic step-up approach is effective and favored over minimally invasive surgical or percutaneous drainage due to reduced risk of organ failure and external pancreatic fistula. However, the approach to PFCs should be individualized for optimal outcomes. A small subgroup of patients does not respond to endotherapy or percutaneous interventions and requires open surgical debridement. Similarly, not all PFCs are amenable to endoscopic drainage and demand alternative modalities like percutaneous or minimally invasive surgical drainage.

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American Gastroenterological Association Clinical Practice Update: Management of Pancreatic Necrosis

Cited by 440 publications

References 43 publications

Delayed referral increases the need for surgery and intervention in patients with acute pancreatitis

Delayed referral increases the need for surgery and intervention in patients with acute pancreatitis

A glimpse of antimicrobial resistance gene diversity in kefir and yoghurt

Endoscopic Management of Pancreatic Fluid Collections: An Update

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