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Medicina
Special Issues
Management of Severe Acute Pancreatitis
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Management of Severe Acute Pancreatitis

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Gastroenterology & Hepatology".

Deadline for manuscript submissions: closed (10 May 2022) | Viewed by 23808

Special Issue Editors

Dr. Dániel Pécsi

E-Mail Website
Guest Editor
Division of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pecs, Hungary
Interests: acute pancreatitis; endoscopy; ERCP; quality improvement
Dr. Áron Vincze

E-Mail Website
Guest Editor
Division of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pecs, Hungary
Interests: acute pancreatitis; ERCP; post-ERCP pancreatitis prophylaxis

Special Issue Information

Dear Colleagues, 

Acute pancreatitis is the most common gastrointestinal disorder leading to hospital admission in the United States, and its incidence is rising steadily. Severe cases carry a high risk of long-term morbidity and mortality. Unfortunately, no specific drug or treatment is available for acute pancreatitis, but it is possible to optimize the general management of these patients to improve outcomes. There are several interesting research topics in the field of acute pancreatitis with open questions. Some examples of these topics are as follows. The optimal risk assessment of acute pancreatitis patients is essential to recognize severe cases early. The optimization of fluid, enteral nutrition and antibiotic therapies should also be highlighted. When local complications occur (e.g., an infected fluid collection develops), percutaneous or endoscopic drainage could be necessary to avoid more invasive surgical methods, but the choice of the best method is important. Additionally, with hypertriglyceridemia-induced pancreatitis, therapeutic plasma exchange might be beneficial; however, patient selection is a crucial aspect of this intervention. In gallstone pancreatitis, the judicious use of ERCP is a key point in the treatment.

The aim of this Special Issue is to collect current research in the field of acute pancreatitis. We expect original and review articles about the broad aspects of severe acute pancreatitis management.

Dr. Dániel Pécsi
Dr. Áron Vincze
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • acute pancreatitis
  • risk assessment
  • enteral nutrition
  • antibiotic therapy
  • ERCP
  • plasma exchange
  • endoscopic drainage

Published Papers (5 papers)

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Research

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9 pages, 475 KiB  
Article
Natural Course of Early Detected Acute Peripancreatic Fluid Collection in Moderately Severe or Severe Acute Pancreatitis
by Dong Wook Lee, Ho Gak Kim, Chang Min Cho, Min Kyu Jung, Jun Heo, Kwang Bum Cho, Sung Bum Kim, Kook Hyun Kim, Tae Nyeun Kim, Jimin Han and Hyunsoo Kim
Medicina 2022, 58(8), 1131; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina58081131 - 20 Aug 2022
Cited by 2 | Viewed by 1847
Abstract
Background and Objectives: Acute peripancreatic fluid collection (APFC) is an acute local complication of acute pancreatitis (AP) according to the revised Atlanta classification. Sometimes APFC resolves completely, sometimes it changes into a pseudocyst or walled-off necrosis (WON), so called late complications. The [...] Read more.
Background and Objectives: Acute peripancreatic fluid collection (APFC) is an acute local complication of acute pancreatitis (AP) according to the revised Atlanta classification. Sometimes APFC resolves completely, sometimes it changes into a pseudocyst or walled-off necrosis (WON), so called late complications. The aim of this study is to investigate the natural course of APFC detected on early computed tomography (CT) in moderately severe (MSAP) or severe AP (SAP). Materials and Methods: From October 2014 to September 2015, patients with MSAP or SAP were enrolled if there was APFC within 48 h of onset on imaging studies at six medical centers. The status of fluid collection was followed 4–8 weeks after onset. Initial laboratory findings, CT findings and clinical scoring systems were analyzed. Results: A total of 68 patients were enrolled and APFC was completely resolved in 32 (66.7%) patients in the MSAP group and 9 (34.6%) in the SAP group. Patients with a high bedside index for severity in acute pancreatitis (BISAP) score (≥3 points) were common in the SAP group. C-reactive protein (CRP) after 48 h from admission and BUN level were also high in the SAP group. In multivariate analysis, BISAP score (≥3 points), elevation of CRP after 48 h (≥150 mg/L) and nasojejunal feeding after 48 h were risk factors for the development of late complications. Conclusions: Spontaneous resolution of APFC was more common in MSAP group and APFC can be changed to pseudocyst or WON in patients with elevated BISAP score, CRP level after 48 h, and non-improved abdominal pain. Full article
(This article belongs to the Special Issue Management of Severe Acute Pancreatitis)
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Review

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15 pages, 1056 KiB  
Review
Post-ERCP Pancreatitis: Prevention, Diagnosis and Management
by Oscar Cahyadi, Nadeem Tehami, Enrique de-Madaria and Keith Siau
Medicina 2022, 58(9), 1261; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina58091261 - 12 Sep 2022
Cited by 18 | Viewed by 11808
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) carries a post-ERCP pancreatitis (PEP) rate of 2–10%, which could be as high as 30–50% in high-risk cases. PEP is severe in up to 5% of cases, with potential for life-threatening complications, including multi-organ failure, peripancreatic fluid collections, and [...] Read more.
Endoscopic retrograde cholangiopancreatography (ERCP) carries a post-ERCP pancreatitis (PEP) rate of 2–10%, which could be as high as 30–50% in high-risk cases. PEP is severe in up to 5% of cases, with potential for life-threatening complications, including multi-organ failure, peripancreatic fluid collections, and death in up to 1% of cases. The risk of PEP is potentially predictable and may be modified with pharmacological measures and endoscopist technique. This review covers the definition, epidemiology and risk factors for PEP, with a focus on the latest evidence-based medical and endoscopic strategies to prevent and manage PEP. Full article
(This article belongs to the Special Issue Management of Severe Acute Pancreatitis)
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11 pages, 320 KiB  
Review
Predicting Severity of Acute Pancreatitis
by Dong Wook Lee and Chang Min Cho
Medicina 2022, 58(6), 787; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina58060787 - 11 Jun 2022
Cited by 20 | Viewed by 5136
Abstract
Acute pancreatitis has a diverse etiology and natural history, and some patients have severe complications with a high risk of mortality. The prediction of the severity of acute pancreatitis should be achieved by a careful ongoing clinical assessment coupled with the use of [...] Read more.
Acute pancreatitis has a diverse etiology and natural history, and some patients have severe complications with a high risk of mortality. The prediction of the severity of acute pancreatitis should be achieved by a careful ongoing clinical assessment coupled with the use of a multiple-factor scoring system and imaging studies. Over the past 40 years, various scoring systems have been suggested to predict the severity of acute pancreatitis. However, there is no definite and ideal scoring system with a high sensitivity and specificity. The interest in new biological markers and predictive models for identifying severe acute pancreatitis testifies to the continued clinical importance of early severity prediction. Although contrast-enhanced computed tomography (CT) is considered the gold standard for diagnosing pancreatic necrosis, early scanning for the prediction of severity is limited because the full extent of pancreatic necrosis may not develop within the first 48 h of presentation. This article provides an overview of the available scoring systems and biochemical markers for predicting severe acute pancreatitis, with a focus on their characteristics and limitations. Full article
(This article belongs to the Special Issue Management of Severe Acute Pancreatitis)
10 pages, 1256 KiB  
Review
Intra-Abdominal Hypertension: A Systemic Complication of Severe Acute Pancreatitis
by Carla Mancilla Asencio and Zoltán Berger Fleiszig
Medicina 2022, 58(6), 785; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina58060785 - 10 Jun 2022
Cited by 9 | Viewed by 2842
Abstract
Patients with severe acute pancreatitis (SAP) present complications and organ failure, which require treatment in critical care units. These extrapancreatic complications determine the clinical outcome of the disease. Intra-abdominal hypertension (IAH) deteriorates the prognosis of SAP. In this paper, relevant recent literature was [...] Read more.
Patients with severe acute pancreatitis (SAP) present complications and organ failure, which require treatment in critical care units. These extrapancreatic complications determine the clinical outcome of the disease. Intra-abdominal hypertension (IAH) deteriorates the prognosis of SAP. In this paper, relevant recent literature was reviewed, as well as the authors’ own experiences, concerning the clinical importance of IAH and its treatment in SAP. The principal observations confirmed that IAH is a frequent consequence of SAP but is practically absent in mild disease. Common manifestations of AP such as pain, abdominal distension, and paralytic ileus contribute to increased abdominal pressure, as well as fluid loss in third space and aggressive fluid replacement therapy. A severe increase in IAP can evolve to abdominal compartment syndrome and new onset organ failure. Conservative measures are useful, but invasive interventions are necessary in several cases. Percutaneous drainage of major collections is preferred when possible, but open decompressive laparotomy is the final possibility in some cases in order to definitively reduce abdominal pressure. Intra-abdominal pressure should be measured in all SAP cases that worsen despite adequate treatment in critical care units. Conservative measures must be introduced to treat IAH, including negative fluid balance, digestive decompression by gastric–rectal tube, and prokinetics, including neostigmine. In the case of insufficient responses to these measures, minimally invasive interventions should be preferred. Full article
(This article belongs to the Special Issue Management of Severe Acute Pancreatitis)
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Other

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7 pages, 3015 KiB  
Case Report
Pancreas Involvement of Extranodal Natural Killer/T-Cell Lymphoma, Nasal Type, Presenting as Acute Pancreatitis: A Case Report
by Dong Wook Lee, Yun Jeong Kim and Chang Min Cho
Medicina 2022, 58(8), 991; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina58080991 - 25 Jul 2022
Cited by 1 | Viewed by 1671
Abstract
Background: The main etiology of acute pancreatitis includes biliary origin and alcohol, although various other causes include drugs (i.e., L-asparaginase) or malignant tumors. Since accurate identification of etiologies is crucial for determining therapeutic planning, the assessment of cause should be performed as early [...] Read more.
Background: The main etiology of acute pancreatitis includes biliary origin and alcohol, although various other causes include drugs (i.e., L-asparaginase) or malignant tumors. Since accurate identification of etiologies is crucial for determining therapeutic planning, the assessment of cause should be performed as early as possible. Case presentation: A 57-year-old Korean man was admitted for chemotherapy. The patient did not drink alcohol for religious reason. 26 days prior to admission, a 4 cm-sized testicular mass was observed in ultrasound and he received right radial orchiectomy. Extranodal natural killer/T-cell lymphoma, nasal type, was diagnosed. After confirming no additional abnormal findings, chemotherapy (using the regimens Dexamethasone, methotrexate, ifosfamide, L-asparaginase, and etoposide) was begun. On Day 8 of chemotherapy, L-asparaginase was started and he complained of sudden onset epigastric pain after 2 days. Acute pancreatitis was diagnosed and, in order to determine if the acute pancreatitis occurred due to L-asparaginase or pancreas involvement of extranodal natural killer/T-cell lymphoma, endoscopic ultrasonography guided fine needle biopsy was performed and observed diffusely infiltrated tumor cells. Therefore, he was given a final diagnosis of acute pancreatitis due to pancreas involvement of extranodal natural killer/T-cell lymphoma, nasal type. Discussion: Acute pancreatitis caused by pancreas involvement of extranodal natural killer/T-cell lymphoma, nasal type, is a very rare disease but can occur during chemotherapy. To identify the cause of acute pancreatitis, endoscopic ultrasonography guided fine needle biopsy can be considered. Full article
(This article belongs to the Special Issue Management of Severe Acute Pancreatitis)
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