Pancreatitis

Notes: Cui, Mei Lan

Kim, Kook Hyun

Kim, Ho Gak

Han, Jimin

Kim, Hyunsoo

Cho, Kwang Bum

Jung, Min Kyu

Cho, Chang Min

Kim, Tae Nyeun

eng

Multicenter Study

Research Support, Non-U.S. Gov’t

2013/12/12 06:00

Dig Dis Sci. 2014 May;59(5):1055-62. doi: 10.1007/s10620-013-2967-4. Epub 2013 Dec 11.

URL: http://www.ncbi.nlm.nih.gov/pubmed/24326631

Author Address: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, 317-1 Daemyung 5-dong Nam-gu, Taegu, 705-717, Korea, cyl0808@hanmail.net.

 

 

Reference Type:  Journal Article

Record Number: 4638Author: da Costa, D. W., Boerma, D., van Santvoort, H. C., Horvath, K. D., Werner, J., Carter, C. R., Bollen, T. L., Gooszen, H. G., Besselink, M. G. and Bakker, O. J.

Year: 2014

Title: Staged multidisciplinary step-up management for necrotizing pancreatitis

Journal: Br J Surg

Volume: 101

Issue: 1

Pages: e65-79

Date: Jan

Short Title: Staged multidisciplinary step-up management for necrotizing pancreatitis

Alternate Journal: The British journal of surgery

ISSN: 1365-2168 (Electronic)

0007-1323 (Linking)

DOI: 10.1002/bjs.9346

Accession Number: 24272964

Keywords: Antibiotic Prophylaxis/methods

Biopsy, Fine-Needle/methods

Compartment Syndromes/etiology/surgery

Decompression, Surgical/methods

Diagnostic Imaging/methods

Drainage/methods

Endoscopy, Gastrointestinal/methods

Fluid Therapy/methods

Forecasting

Humans

Laparoscopy/methods

Nutritional Support/methods

Pancreatitis, Acute Necrotizing/diagnosis/*therapy

Patient Care Team/organization & administration

Severity of Illness Index

Treatment Outcome

Abstract: BACKGROUND: Some 15 per cent of all patients with acute pancreatitis develop necrotizing pancreatitis, with potentially significant consequences for both patients and healthcare services. METHODS: This review summarizes the latest insights into the surgical and medical management of necrotizing pancreatitis. General management strategies for the treatment of complications are discussed in relation to the stage of the disease. RESULTS: Frequent clinical evaluation of the patient’s condition remains paramount in the first 24-72 h of the disease. Liberal goal-directed fluid resuscitation and early enteral nutrition should be provided. Urgent endoscopic retrograde cholangiopancreatography is indicated when cholangitis is suspected, but it is unclear whether this is appropriate in patients with predicted severe biliary pancreatitis without cholangitis. Antibiotic prophylaxis does not prevent infection of necrosis and antibiotics are not indicated as part of initial management. Bacteriologically confirmed infections should receive targeted antibiotics. With the more conservative approach to necrotizing pancreatitis currently advocated, fine-needle aspiration culture of pancreatic or extrapancreatic necrosis will less often lead to a change in management and is therefore indicated less frequently. Optimal treatment of infected necrotizing pancreatitis consists of a staged multidisciplinary ‘step-up’ approach. The initial step is drainage, either percutaneous or transluminal, followed by surgical or endoscopic transluminal debridement only if needed. Debridement is delayed until the acute necrotic collection has become ‘walled-off’. CONCLUSION: Outcome following necrotizing pancreatitis has improved substantially in recent years as a result of a shift from early surgical debridement to a staged, minimally invasive, multidisciplinary, step-up approach.

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