Abstract
This review highlights advances made in recent years in the diagnosis and management of acute pancreatitis (AP). We focus on epidemiological, clinical, and management aspects of AP. Additionally, we discuss the role of using risk stratification tools to guide clinical decision making. The majority of patients suffer from mild AP, and only a subset develop moderately severe AP, defined as a pancreatic local complication, or severe AP, defined as persistent organ failure. In mild AP, management typically involves diagnostic evaluation and supportive care resulting usually in a short hospital length of stay (LOS). In severe AP, a multidisciplinary approach is warranted to minimize morbidity and mortality over the course of a protracted hospital LOS. Based on evidence from guideline recommendations, we discuss five treatment interventions, including intravenous fluid resuscitation, feeding, prophylactic antibiotics, probiotics, and timing of endoscopic retrograde cholangiopancreatography (ERCP) in acute biliary pancreatitis. This review also highlights the importance of preventive interventions to reduce hospital readmission or prevent pancreatitis, including alcohol and smoking cessation, same-admission cholecystectomy for acute biliary pancreatitis, and chemoprevention and fluid administration for post-ERCP pancreatitis. Our review aims to consolidate guideline recommendations and high-quality studies published in recent years to guide the management of AP and highlight areas in need of research.
Highlights
Acute pancreatitis (AP), especially severe cases, is a major clinical and financial burden in the United States
We review five treatment interventions and four preventive interventions
Important management topics not discussed in this review include critical care management in acute pancreatitis (AP) and late decision making for pancreatitis complicated by infected necrosis, which involves source control with antibiotics and step-up therapy using a combination of percutaneous drainage, endoscopic management, and surgical intervention[7,8,9,10]
Summary
Acute pancreatitis (AP), especially severe cases, is a major clinical and financial burden in the United States. The authors confirm that the funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript
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