Management of Severe Acute Pancreatitis
DOI:
https://doi.org/10.3889/oamjms.2019.720Keywords:
severe acute pancreatitis, managementAbstract
Acute pancreatitis is one of the most common causes of hospitalisation from gastrointestinal diseases. The causes of pancreatitis vary between countries. Acute pancreatitis is classified based on Revised Atlanta classification 2013 as mild, moderately severe and severe acute pancreatitis. Acute pancreatic severity can be stratified by scoring systems such as Ranson’s score, BISAP score, APACHE-II score, SOFA score. In severe acute pancreatitis, to diagnose, abdominal pain raised amylase or lipase, supported imaging finding and organ failure. Organ failure can be diagnosed by using Modified Marshall Scoring System. Management is started conservatively, which are fluid resuscitation, enteral nutrition, analgesics, and antibiotics. Surgical management is indicated when infected pancreas necrosis is detected. In this review, we will discuss the current management based on recent research.
Downloads
Metrics
Plum Analytics Artifact Widget Block
References
Pendharkar SA, Mathew J, Zhao J, Windsor JA, Exeter J, Petrov MS. Ethnic and geographic of pancreatitis and post- mellitus in New Zealand : a nationwide population- based study. N Z Med J. 2017; 130(1450):55-68.
Fan J, Ding L, Lu Y, Zheng J, Zeng Y, Huang C. Epidemiology and Etiology of Acute Pancreatitis in Urban and Suburban Areas in Shanghai: A Retrospective Study. Gastroenterol Res Pract. 2018; 2018:1-8. https://doi.org/10.1155/2018/1420590 PMid:30158961 PMCid:PMC6109519
Manrai M, Kochhar R, Thandassery RB, Alfadda AA, Sinha SK. The Revised Atlanta Classification of Acute Pancreatitis: A Work Still in Progress? JOP J Pancreas JOP J Pancreas Jul. 2015; 16(164):356-64.
Foster BR, Jensen KK, Bakis G, Shaaban AM, Coakley F V. Revised Atlanta Classification for Acute Pancreatitis: A Pictorial Essay-Erratum. RadioGraphics. 2019; 39(3):912-912. https://doi.org/10.1148/rg.2019194003 PMid:31059405
Zerem E. Treatment of severe acute pancreatitis and its complications. World J Gastroenterol. 2014; 20(38):13879-92. https://doi.org/10.3748/wjg.v20.i38.13879 PMid:25320523 PMCid:PMC4194569
Aggarwal A, Manrai M, Kochhar R. Fluid resuscitation in acute pancreatitis. World J Gastroenterol. 2014; 20(48):18092-103. https://doi.org/10.3748/wjg.v20.i48.18092 PMid:25561779 PMCid:PMC4277949
de-Madaria E, Herrera-Marante I, González-Camacho V, Bonjoch L, Quesada-Vázquez N, Almenta-Saavedra I, et al. Fluid resuscitation with lactated Ringer's solution vs normal saline in acute pancreatitis: A triple-blind, randomized, controlled trial. United Eur Gastroenterol J. 2018; 6(1):63-72. https://doi.org/10.1177/2050640617707864 PMid:29435315 PMCid:PMC5802674
Iqbal U, Anwar H, Scribani M. Ringer's lactate versus normal saline in acute pancreatitis : systematic review and meta-analysis. J Dig Dis. 2018; 19(6):335-41. https://doi.org/10.1111/1751-2980.12606 PMid:29732686
Choosakul S, Harinwan K, Chirapongsathorn S, Opuchar K, Sanpajit T, Piyanirun W, Puttapitakpong C. Comparison of normal saline versus Lactated Ringer's solution for fluid resuscitation in patients with mild acute pancreatitis, A randomized controlled trial. Pancreatology. 2018; S1424-3903. https://doi.org/10.1016/j.pan.2018.04.016 PMid:29754857
Wu BU, Hwang JQ, Gardner TH, Repas K, Delee R, Yu S, Smith B, Banks PA, Conwell DL. Lactated Ringer's solution reduces systemic inflammation compared with saline in patients with acute pancreatitis. 2011; 9(8):710-17. https://doi.org/10.1016/j.cgh.2011.04.026 PMid:21645639
Song J, Zhong Y, Lu X, Kang X, Wang Y, Guo W, Liu J, Yang Y, Pei L. Enteral nutrition provided within 48 hours after admission in severe acute pancreatitis: A systematic review and meta-analysis. Medicine. 2018; 97(34):e11871. https://doi.org/10.1097/MD.0000000000011871 PMid:30142782 PMCid:PMC6112989
Li Y, Yu T, Chen G, et al. Enteral nutrition within 48 hours of admission improves clinical outcomes if acute pancreatitis by reducing complications: a meta -analysis. Plos One . 2013; 8(6):e64926. https://doi.org/10.1371/journal.pone.0064926 PMid:23762266 PMCid:PMC3675100
Shah AP, Mourad MM, Bramhall SR. Acute pancreatitis: current perspectives on diagnosis and management. Dovepress. 2018; 11:77-85. https://doi.org/10.2147/JIR.S135751 PMid:29563826 PMCid:PMC5849938
Qi D, Yu B, Huang J, Peng M. Meta-analysis of Early Enteral Nutrition Provided Within 24 hours of Admission on Clinical Outcomes in Acute Pancreatitis. J Parenter Enteral Nutr. 2018; 42(7):1139-47. https://doi.org/10.1002/jpen.1139 PMid:29377204
Vieira JP, de Araujo GF, de Azevedo RA, Goldenberg A, Linhares MM. Parenteral Nutrition versus Enteral Nutrition in Severe Acute Pancreatitis. Acta Cirurgica Brasileira. 2010; 25(5):450-54. https://doi.org/10.1590/S0102-86502010000500012 PMid:20877957
Li W, Liu J, Zhao S, Li J. Safety and efficacy of total parenteral nutrition versus total enteral nutrition for patients with severe acute pancreatitis: a meta-analysis. J Int Med Res. 2018; 46(9):3948-58. https://doi.org/10.1177/0300060518782070 PMid:29962261 PMCid:PMC6136006
Yi F, Ge L, Zhao J, Lei Y, Zhou F, Chen Z, Zhu Y, Xia B. Meta-analysis: total parenteral nutrition versus total enteral nutrition in predicted severe acute pancreatitis. Intern Med. 2012; 51(6):523-30. https://doi.org/10.2169/internalmedicine.51.6685 PMid:22449657
Quan H, Wang X, Guo C. A Meta-analysis of Enteral Nutrition and Total Parenteral Nutrition in Patients with Acute Pancreatitis. Gastroenterol Res Pract. 2011:698248. https://doi.org/10.1155/2011/698248 PMid:21687619 PMCid:PMC3113258
Zarnescu NO, Barbu ST, Zamescu EC, Costea R, Neagu S. Management of Acute Pancreatitis in Early Stage. Maedica. 2015; 10(3):257-63.
Zhu Y, Yin H, Zhang R, Ye X, Wei J. Nasogastric Nutrition versus Nasojejunal Nutrition in Patients with Severe Acute Pancreatitis: A Meta-Analysis of Randomized Controlled Trials. Gastroenterol Res Pract. 2016:1-8. https://doi.org/10.1155/2016/6430632 PMid:27340401 PMCid:PMC4909901
Chang YS, Fu HQ, Xiao YM, Liu JC. Nasogastric or nasojejunal feeding in predicted severe acute pancreatitis: a meta-analysis. Crit Care. 2013; 17:R118. https://doi.org/10.1186/cc12790 PMid:23786708 PMCid:PMC4057382
Singh N, Sharma B, Sharma M, Sachdev V, Bhardwaj P, Mani K, Joshi YK, Saraya A. Evaluation of early enteral feeding through nasogastric and nasojejunal tube in severe acute pancreatitis: a noninferiority randomized controlled trial. Pancreas. 2012; 41(1):153-9. https://doi.org/10.1097/MPA.0b013e318221c4a8 PMid:21775915
Kumar A, Singh N, Prakash S, Saraya A, Joshi YK. Early enteral nutrition in severe acute pancreatitis: a prospective randomized controlled trial comparing nasojejunal and nasogastric routes. J Clin Gastroenterol. 2006; 40(5):431-4. https://doi.org/10.1097/00004836-200605000-00013 PMid:16721226
Eatoc FC, Chong P, Menezes N, Murray L, McKay CJ, Carter CR, Imrie CW. A randomized study of early nasogastric versus nasojejunal feeding in severe acute pancreatitis. Am J Gastroenterol. 2005; 100(2):432-9. https://doi.org/10.1111/j.1572-0241.2005.40587.x PMid:15667504
Mourad MM, Evans RPT, Kalidindi V, Navaratnam R, Dyorkin L, Bramhall SR. Prophylactic antibiotics in acute pancreatitis: endless debate. Ann R Surg Engl. 2017; 99(2):107-112. https://doi.org/10.1308/rcsann.2016.0355 PMid:27917667 PMCid:PMC5392851
Basurto Ona X, Rigau Comas D, Urrutia G - Opioids for acute pancreatitis pain. Cochrane Database Syst Rev. 2013; 7:CD009179. https://doi.org/10.1002/14651858.CD009179.pub2
Schorn S, Ceyhan GO, Tieftrunk E, Friess H, Demir IE. Pain management in acute pancreatitis. Pancreapedia: Exocrine Pancreas Knowledge Base. 2015.
. Stigliano S, Sternby H, Madaria E, Capurso G, Petrov MS. Early management of acute pancreatitis: A review of best evidence. Digestive and Liver Disease. 2017; 49:585-94. https://doi.org/10.1016/j.dld.2017.01.168 PMid:28262458
Uhl W, Buchler M, Malfertheiner P, Beger H, Adler G, Gaus W, The G. A randomised, double blind, multicenter trial of octreotide in moderate to severe acute pancreatitis. Gut. 1999; 45(1):97-104. https://doi.org/10.1136/gut.45.1.97 PMid:10369711 PMCid:PMC1727562
Paran H, Mayo A, Paran D, Neufeld D. Octreotide treatment inpatients with severe acute pancreatitis. Digestive diseases and sciences. 2000; 45(11):2247-51. https://doi.org/10.1023/A:1026679106463 PMid:11215748
Rasch S, Phillip V, Reichel S, Rau B, Zapf C, Rosenahl J, et al.. Open surgical versus minimal invasive necrosectomy of pancreas- a retrospective multicenter analysis of The German Pancreatitis Study. Plos One. 2016; 11(9):e0163651. https://doi.org/10.1371/journal.pone.0163651 PMid:27668746 PMCid:PMC5036800
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2019 Gontar Alamsyah Siregar, Ginanda Putra Siregar (Author)

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0)
