Efstratios Koutroumpakis1, Adam Slivka1, Alessandro Furlan2, Anil K Dasyam2, Anwar Dudekula3, Julia B Greer1, David C Whitcomb1, Dhiraj Yadav1, Georgios I Papachristou4. 1. Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh Medical Center, United States. 2. Division of Abdominal Imaging, Department of Radiology, University of Pittsburgh Medical Center, United States. 3. Division of General Internal Medicine, Department of Medicine, University of Pittsburgh Medical Center, United States. 4. Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh Medical Center, United States; Division of Gastroenterology, Department of Medicine, Veterans Affairs Pittsburgh Health System, Pittsburgh, PA, United States. Electronic address: papachri@pitt.edu.
Abstract
BACKGROUND/ OBJECTIVES: Acute pancreatitis (AP) management remains largely supportive and can be challenging in patients with severe disease. This study aims to describe a ten-year US tertiary-center experience in managing AP patients. METHODS: Clinical management and outcomes of 400 prospectively enrolled AP patients stratified by the Revised Atlanta Classification were analyzed; trends in management between early (2004-2008) and late enrollment phase (2009-2014) were assessed. RESULTS: Fifty-two% of patients were classified as mild AP (MAP); moderately severe (MoAP) and severe (SAP) grades contained 23.5% and 24.5% of participants. Intravenous fluid administration during the first 24 h (MAP 3.7, MoAP 4.7, and SAP 4.8 L), need for ICU (6%, 23%, 93%), and nutritional support (7%, 51%, 90%) increased significantly with greater AP severity (p < 0.001). One hundred fifty five (39%) patients developed necrotizing AP, of which 41% received prophylactic antibiotics, and 44% underwent pancreatic drainage/debridement. Prophylactic antibiotics (58% vs. 27%) and interventions (63% vs. 27%) were noted more frequently in SAP than MoAP (p < 0.001). Enteral nutrition (18% vs. 30%) and minimally invasive pancreatic interventions (19% vs. 41%) were more commonly used in the late phase (p < 0.05). The overall median length of hospitalization was 7 days reaching 29 days in SAP group. Mortality was 5%; all deaths occurred in SAP group. CONCLUSIONS: This study provides an extensive report on clinical management of AP and its trends overtime. Pancreatic intervention is required in less than 50% of patients with necrotizing pancreatitis. Utilization of enteral nutrition and minimally invasive pancreatic interventions has been increasing over time. Published by Elsevier B.V.
BACKGROUND/ OBJECTIVES:Acute pancreatitis (AP) management remains largely supportive and can be challenging in patients with severe disease. This study aims to describe a ten-year US tertiary-center experience in managing AP patients. METHODS: Clinical management and outcomes of 400 prospectively enrolled AP patients stratified by the Revised Atlanta Classification were analyzed; trends in management between early (2004-2008) and late enrollment phase (2009-2014) were assessed. RESULTS: Fifty-two% of patients were classified as mild AP (MAP); moderately severe (MoAP) and severe (SAP) grades contained 23.5% and 24.5% of participants. Intravenous fluid administration during the first 24 h (MAP 3.7, MoAP 4.7, and SAP 4.8 L), need for ICU (6%, 23%, 93%), and nutritional support (7%, 51%, 90%) increased significantly with greater AP severity (p < 0.001). One hundred fifty five (39%) patients developed necrotizing AP, of which 41% received prophylactic antibiotics, and 44% underwent pancreatic drainage/debridement. Prophylactic antibiotics (58% vs. 27%) and interventions (63% vs. 27%) were noted more frequently in SAP than MoAP (p < 0.001). Enteral nutrition (18% vs. 30%) and minimally invasive pancreatic interventions (19% vs. 41%) were more commonly used in the late phase (p < 0.05). The overall median length of hospitalization was 7 days reaching 29 days in SAP group. Mortality was 5%; all deaths occurred in SAP group. CONCLUSIONS: This study provides an extensive report on clinical management of AP and its trends overtime. Pancreatic intervention is required in less than 50% of patients with necrotizing pancreatitis. Utilization of enteral nutrition and minimally invasive pancreatic interventions has been increasing over time. Published by Elsevier B.V.
Entities:
Keywords:
Acute pancreatitis; Management; Outcomes; Revised Atlanta classification
Authors: Jorge D Machicado; Amir Gougol; Pedram Paragomi; Stephen J OʼKeefe; Kenneth Lee; Adam Slivka; David C Whitcomb; Dhiraj Yadav; Georgios I Papachristou Journal: Pancreas Date: 2018-10 Impact factor: 3.327
Authors: Nicole L Komara; Pedram Paragomi; Phil J Greer; Anette S Wilson; Cameron Breze; Georgios I Papachristou; David C Whitcomb Journal: Am J Physiol Gastrointest Liver Physiol Date: 2020-09-02 Impact factor: 4.052
Authors: Kohtaro Ooka; Harkirat Singh; Matthew G Warndorf; Melissa Saul; Andrew D Althouse; Anil K Dasyam; Pedram Paragomi; Anna Evans Phillips; Amer H Zureikat; Kenneth K Lee; Adam Slivka; Georgios I Papachristou; Dhiraj Yadav Journal: Pancreatology Date: 2020-11-29 Impact factor: 3.977
Authors: Bassem Matta; Amir Gougol; Xiaotian Gao; Nageshwar Reddy; Rupjyoti Talukdar; Rakesh Kochhar; Mahesh Kumar Goenka; Aiste Gulla; Jose A Gonzalez; Vikesh K Singh; Miguel Ferreira; Tyler Stevens; Sorin T Barbu; Haq Nawaz; Silvia C Gutierrez; Narcis O Zarnescu; Gabriele Capurso; Jeffrey Easler; Konstantinos Triantafyllou; Mario Pelaez-Luna; Shyam Thakkar; Carlos Ocampo; Enrique de-Madaria; Gregory A Cote; Bechien U Wu; Pedram Paragomi; Ioannis Pothoulakis; Gong Tang; Georgios I Papachristou Journal: Clin Gastroenterol Hepatol Date: 2019-11-09 Impact factor: 13.576
Authors: Aman Khurana; Leslie W Nelson; Charles B Myers; Fatih Akisik; Brooke R Jeffrey; Frank H Miller; Pardeep Mittal; Desiree Morgan; Koenraad Mortele; Peter Poullos; Dushyant Sahani; Kumar Sandrasegaran; Temel Tirkes; Atif Zaheer; Bhavik N Patel Journal: Abdom Radiol (NY) Date: 2020-05