Management of severe acute pancreatitis: itʼs all about timing
- 1 April 2007
- journal article
- review article
- Published by Ovid Technologies (Wolters Kluwer Health) in Current Opinion in Critical Care
- Vol. 13 (2), 200-206
- https://doi.org/10.1097/mcc.0b013e328015b8af
Abstract
This study provides an update on the treatment of severe acute pancreatitis (SAP) with emphasis on nutrition, infection-prophylaxis, biliary pancreatitis, surgical intervention and new randomized controlled trials. The most relevant new insights are: (i) early enteral nutrition in SAP is not only capable of reducing infectious complications but may also reduce mortality; (ii) there is increasing evidence that antibiotic-prophylaxis is not capable of preventing infectious complications in SAP; (iii) probiotic-prophylaxis is being considered as an alternative with promising experimental results; (iv) in biliary pancreatitis, early endoscopic retrograde cholangiography with sphincterotomy (within 48 h) is beneficial in case of ampullary obstruction, although it may be withheld in the event of negative endoscopic ultrasound; (v) surgical intervention for infected (peri-)pancreatic necrosis is increasingly being postponed; (vi) minimally invasive strategies are being considered as a full alternative for necrosectomy by laparotomy in infected (peri-)pancreatic necrosis; (vii) the Atlanta classification should no longer be used to describe computed tomography findings in acute pancreatitis; and (viii) only five randomized controlled trials of patients with acute pancreatitis are currently registered in the international trial registries. Timing of intervention is becoming increasingly important in SAP management.Keywords
This publication has 46 references indexed in Scilit:
- Evaluation of intestinal mucosal permeability function in patients with acute pancreatitisThe American Journal of Surgery, 2006
- ESPEN Guidelines on Enteral Nutrition: PancreasClinical Nutrition, 2006
- Total Enteral Nutrition as Prophylactic Therapy for Pancreatic Necrosis Infection in Severe Acute PancreatitisPancreatology, 2006
- Surgical intervention in patients with necrotizing pancreatitisBritish Journal of Surgery, 2006
- Nutrition Support in Acute Pancreatitis: A Systematic Review of the LiteratureJournal of Parenteral and Enteral Nutrition, 2006
- Semi‐Elemental Formula or Polymeric Formula: Is There a Better Choice for Enteral Nutrition in Acute Pancreatitis? Randomized Comparative StudyJournal of Parenteral and Enteral Nutrition, 2006
- A Randomized Controlled Trial of Enteral versus Parenteral Feeding in Patients with Predicted Severe Acute Pancreatitis Shows a Significant Reduction in Mortality and in Infected Pancreatic Complications with Total Enteral NutritionDigestive Surgery, 2006
- Chronic intermittent vomiting after scoliosis surgeryGut, 2005
- Clinical Trial Registration: A Statement from the International Committee of Medical Journal EditorsThe New England Journal of Medicine, 2004
- Prophylactic antibiotic use in severe acute pancreatitis: hemlock, help, or hype?Gastroenterology, 2004