Management of patients after recovering from acute severe biliary pancreatitis

Dedemadi, Georgia; Nikolopoulos, Manolis; Kalaitzopoulos, Ioannis; Sgourakis, George

doi:10.3748/wjg.v22.i34.7708

Cited by 22 publications

(15 citation statements)

References 75 publications

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“…41.9% of severe cases had pancreatic necrosis whereas its reported incidence is 20-25% in the patients with severe pancreatitis [7] . Pseudocyst/walled off necrosis was observed in only 4.2% of the patients and was comparable to the studies [8] where it was 6-8%. Overall vascular complications are rare and, in our study, it was observed in 2%.…”

Section: Discussionsupporting

confidence: 86%

Clinical profile, severity stratification, complications and management of acute gall stone induced pancreatitis: A prospective observational descriptive study

Mahajan¹,

Sharma²,

Tomar³

2021

Int. J. Surg. Sci.

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Acute biliary pancreatitis is common surgical emergency with wide array of symptoms. Revised Atlanta Classification has devised criteria for the diagnosis of the pancreatitis and has defined the severity of pancreatitis and various complications arising from the pancreatitis. Early diagnosis is imperative to start the management of the patients which is usually supportive. In our study, we assessed clinical profile, severity, complications and managed patients based on standard guidelines. Majority of cases, in our study, followed a mild course and a few developed local or systemic complications. Definitive treatment involved early cholecystectomy for mild cases wherever possible and interval cholecystectomy for the severe cases. Management of complications has improved with step-up approach. Recurrence of acute pancreatitis was witnessed when patient did not undergo cholecystectomy or was waiting for the definitive procedure.

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Section: Discussionsupporting

confidence: 86%

Clinical profile, severity stratification, complications and management of acute gall stone induced pancreatitis: A prospective observational descriptive study

Mahajan¹,

Sharma²,

Tomar³

2021

Int. J. Surg. Sci.

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“…The therapeutic choices in later phase of SAP are based on the development and evolution of (peri) pancreatic fluid-necrotic gatherings and their septic complications [34]. The pathological basis of therapeutic program in the SAP are linked on the grade of impairment of pancreatic parenchyma and peripancreatic tissue.…”

Section: Discussionmentioning

confidence: 99%

Management of Complicants of Acute Pancreatitis

Neri¹,

Tartaglia²,

Fersini³

et al. 2018

Int J Gastroenterol Disord Ther

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Background /Aim: Acute pancreatitis (AP) is a complex disease with various etiology, most frequent biliary and alcoholic. Clinical presentation shows different degree of severity with biphasic evolution. The aim of this study is to evaluate the surgical procedures with mini-invasive approach as preferred choice in patients with pancreatitis.Methods: Biliary lithiasis and excessive alcohol consumption are the most frequent causes, reaching as a whole the total incidence of 80%. Moreover numerous other causes of pancreatitis are recognized, which on the whole represent 20% of the total. In our Institution from 2000 to 2017 we have observed and treated 351 pancreatitis: 339 acute biliary pancreatitis and 12 chronic alcoholic pancreatitis. Mean age was 49 years (Range: 30-86 yrs). Male female ratio was 1:1, 33. Biliary etiology was confirmed in 339 pts, including 22 pts with recurrent unexplained pancreatitis at initial etiological assessment. The clinical morphological assessment of 339 acute biliary pancreatitis was the following: mild 182, moderate-severe 78, severe 61, early severe 18. We employed a biphasic therapeutic program to control and treat general complications in the first phase. In biliary pathogenesis endoscopic retrograde cholangiopancreatography/ endoscopic sphincterotomy ( ERCP-ES) to assure papillary patency after cholestasis verification. In the second phase control and treatment of pancreatic gatherings and belated acute postnecrotic pseudocysts. Results:In biliary pancreatitis, the therapeutic program includes assuring papillary patency and CBD cleaning with ERCP/ES. After ERCP, it is necessary to perform laparoscopic cholecystectomy (LC) to complete gallstones treatment. The timing of LC is connected with AP evolution because it is preferable to wait for the stabilization of the general conditions. Treatment of the later phase of AP consists in control and treatment of local complications: infections, haemorrhage, pancreatic and peripancreatic fluid necrotic collections. Conclusions:In summary in AP it should be preferred the mini-invasive approach for various clinical manifestations.There is a evident prevalence of men vs women in pancreatitis with alcoholic etiology; more little prevalence in women for biliary

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“…Another report by Dedemadi and his colleagues [65] published in 2016 noted that ERCP and ES in cases with AP who can not undergo cholecystectomy developed biliary events 0%-28.6%, recurrent pancreatitis 0%-8.2%, mortality 3%-4.7%. Other cases under conservative treatment had biliary events 9.4%-14.3%, recurrent pancreatitis 12%-23%, mortality 3.9%.…”

Section: Elective Ercp To Prevent Pancreatitis Recurrencementioning

confidence: 99%

“…Moreover, If we consider surgery for pancreatic cystic collections, pseudocysyt and or walled off necrosis, it should be performed at the same time with cholecystectomy [65].…”

mentioning

confidence: 99%

Endoscopic Retrograde Cholangiopancreatography in Acute Biliary Pancreatitis

Sarıtaş¹,

Üstündağ²

2022

Recent Advances in Pancreatitis

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Acute pancreatitis (AP) is the most serious emergent disease in the gastroenterology field. The most common cause of AP is naturally gallstones. The most cases have mild disease and the illness limits itself in a short time period. In 15–20% of cases, the severe form of acute biliary pancreatitis (ABP) develops. Some patients have concomitant cholangitis. In these patients, releiving biliary obstruction with endoscopic retrograde cholangiography (ERCP) and endoscopic sphincterotomy (ES) is essential. However, correct timing of ERCP is a debate. While some authors and guidelines suggested that ERCP can be performed in first 24 hours, the others suggested its use during the first 72 hours. In the first 24 hours, ERCP is diffucult to apply due to ampullary edema and general ill situation of the patient. Rather than ERCP, agressive fluid replacement and supportive therapy are very much important in the first 72 hours of admission. Moreover, there is no consensus on timing of ERCP in patients with severe pancreatitis without cholangitis. But all international guidelines suggested that ERCP should be perfomed in all patients with mild or severe pancreatitis together with concomitant cholangitis during the first 72 hours. After resolution of ABP, cholecystectomy should be performed to prevent recurrent pancreatitis during the same hospitalization period (index cholecystectomy). If the patient is not suitable for cholecystectomy, ERCP and ES should be done to prevent further attacks of acute pancreatitis.

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Management of patients after recovering from acute severe biliary pancreatitis

Cited by 22 publications

References 75 publications

Clinical profile, severity stratification, complications and management of acute gall stone induced pancreatitis: A prospective observational descriptive study

Clinical profile, severity stratification, complications and management of acute gall stone induced pancreatitis: A prospective observational descriptive study

Management of Complicants of Acute Pancreatitis

Endoscopic Retrograde Cholangiopancreatography in Acute Biliary Pancreatitis

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