PURPOSE OF REVIEW: 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. RECENT FINDINGS: 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. SUMMARY: Timing of intervention is becoming increasingly important in SAP management.
PURPOSE OF REVIEW: 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. RECENT FINDINGS: 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. SUMMARY: Timing of intervention is becoming increasingly important in SAP management.
Authors: Kent J Fanning; Thomas A Robertson; Johannes B Prins; Michael S Roberts Journal: Antimicrob Agents Chemother Date: 2011-03-14 Impact factor: 5.191
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Authors: Katalin Márta; Anikó N Szabó; Dániel Pécsi; Péter Varjú; Judit Bajor; Szilárd Gódi; Patrícia Sarlós; Alexandra Mikó; Kata Szemes; Mária Papp; Tamás Tornai; Áron Vincze; Zsolt Márton; Patrícia A Vincze; Erzsébet Lankó; Andrea Szentesi; Tímea Molnár; Roland Hágendorn; Nándor Faluhelyi; István Battyáni; Dezső Kelemen; Róbert Papp; Attila Miseta; Zsófia Verzár; Markus M Lerch; John P Neoptolemos; Miklós Sahin-Tóth; Ole H Petersen; Péter Hegyi Journal: BMJ Open Date: 2017-09-14 Impact factor: 2.692