scholarly journals Improving the Outcome of Acute Pancreatitis

2016 ◽  
Vol 34 (5) ◽  
pp. 540-545 ◽  
Author(s):  
Marco J. Bruno ◽  
Keyword(s):  
Acute Pancreatitis ◽  
Randomized Trial ◽  
Organ Failure ◽  
Large Scale ◽  
Randomized Study ◽  
Necrotizing Pancreatitis ◽  
Tube Feeding ◽  
Percutaneous Catheter Drainage ◽  
Endoscopic Necrosectomy ◽  
Multicenter Randomized Trial

Acute pancreatitis (AP) is the most common indication for hospital admission and its incidence is rising. It has a variable prognosis, which is mainly dependent upon the development of persistent organ failure and infected necrotizing pancreatitis. In the past few years, based on large-scale multicenter randomized trials, some novel insights regarding clinical management have emerged. In patients with infected pancreatic necrosis, a step-up approach of percutaneous catheter drainage followed by necrosectomy only when the patient does not improve, reduces new-onset organ failure and prevents the need for necrosectomy in about a third of patients. A randomized pilot study comparing surgical to endoscopic necrosectomy in patients with infected necrotizing pancreatitis showed a striking reduction of the pro-inflammatory response following endoscopic necrosectomy. These promising results have recently been tested in a large multicenter randomized trial whose results are eagerly awaited. Contrary to earlier data from uncontrolled studies, a large multicenter randomized trial comparing early (within 24 h) nasoenteric tube feeding compared with an oral diet after 72 h, did not show that early nasoenteric tube feeding was superior in reducing the rate of infection or death in patients with AP at high risk for complications. Although early ERCP does not have a role in the treatment of predicted mild pancreatitis, except in the case of concomitant cholangitis, it may ameliorate the disease course in patients with predicted severe pancreatitis. Currently, a large-scale randomized study is underway and results are expected in 2017.

Fr289 POSTPONED OR IMMEDIATE DRAINAGE OF INFECTED NECROTIZING PANCREATITIS (POINTER): A MULTICENTER RANDOMIZED TRIAL

2021 ◽  
Vol 160 (6) ◽  
pp. S-284
Author(s):  
Lotte Boxhoorn ◽  
Sven M. van Dijk ◽  
Janneke van Grinsven ◽  
Robert C. Verdonk ◽  
Marja A. Boermeester ◽  
...  
Keyword(s):  
Randomized Trial ◽  
Necrotizing Pancreatitis ◽  
Multicenter Randomized Trial

Sa1371 Early Aggressive Fluid Resuscitation for Acute Pancreatitis - Is It Time for Large Multicenter Randomized Trial?

2013 ◽  
Vol 144 (5) ◽  
pp. S-277 ◽  
Author(s):  
Abhishek Choudhary ◽  
Alisha M. Hinds ◽  
Rindi M. Uhlich ◽  
Imran Ashraf ◽  
Sameer Siddique ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Randomized Trial ◽  
Fluid Resuscitation ◽  
Multicenter Randomized Trial ◽  
Aggressive Fluid Resuscitation

scholarly journals Increased circulating total bile acid levels were associated with organ failure in patients with acute pancreatitis

2020 ◽  
Author(s):  
Weiqin Li ◽  
Xiaochun Xie ◽  
Jie Dong ◽  
Guotao Lu ◽  
Kun Gao ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Regression Analysis ◽  
Bile Acid ◽  
Organ Failure ◽  
Roc Curve ◽  
Pancreatic Necrosis ◽  
Early Stage ◽  
Total Bile Acid ◽  
Percutaneous Catheter Drainage ◽  
Tertiary Center

Abstract Background: Recent studies have shown that bile acids (BAs) are closely related to metabolic and inflammatory diseases. Our study aimed to investigate whether circulating total bile acid (TBA) levels were associated with the severity of acute pancreatitis (AP).Methods: We retrospectively collected data on patients diagnosed with AP in a tertiary center from 01 January 2014 to 31 December 2016. The highest TBA value during the first 1,2,3,5,7 days after admission was determined as D1, D2, D3, D5, D7 TBAmax. Patients were divided into the high TBA (HTBA) group and the normal TBA (NTBA) group according to whether the TBAmax was ≥10μmol/L. The prognosis and complications, including death, organ failure (OF) and pancreatic necrosis, were compared between the two groups. Logistic regression analysis and receiving operating characteristic (ROC) curve were used to evaluate the relationship between circulating TBA and organ failure in AP patients.Results: Through stratified analysis of each time period, we found that the incidence of OF in the HTBA group was significantly higher than that in the NTBA group, and the AP severity classification in the HTBA group was more serious than that in the NTBA group. In addition, according to the D7 TBAmax values, the pancreatic necrosis rate, percutaneous catheter drainage (PCD) rate and mortality in the HTBA group were higher than those in the NTBA group. Multivariate regression analysis showed that HTBA (odds ratio (OR), 4.894; P = 0.002) was an independent risk factor for AP complicated with OF, which was verified in the grouping based on D7 TBAmax. ROC analysis revealed that a circulating D7 TBAmax cutoff point of 6.450 umol/L had optimal predictive value for the development of OF in AP patients with an area under the curve of the ROC curve (AUCROC) of 0.777. Conclusions: The increase of circulating TBA in early stage of AP is independently related to organ failure, which indicates the adverse prognosis of AP patients.

scholarly journals Postponed or Immediate Drainage of Infected Necrotizing Pancreatitis (POINTER): A Multicenter Randomized Trial

HPB ◽  
2021 ◽  
Vol 23 ◽  
pp. S728
Author(s):  
L. Boxhoorn ◽  
S.M. van Dijk ◽  
J. van Grinsven ◽  
R.C. Verdonk ◽  
M.A. Boermeester ◽  
...  
Keyword(s):  
Randomized Trial ◽  
Necrotizing Pancreatitis ◽  
Multicenter Randomized Trial

scholarly journals Atlanta Classification for Acute Pancreatitis- A Study Protocol

2021 ◽  
pp. 61-68
Author(s):  
Varun Singh ◽  
Rajasbala Pradeep Dhande ◽  
Gaurav Mishra
Keyword(s):  
Acute Pancreatitis ◽  
Organ Failure ◽  
Scoring System ◽  
Necrotizing Pancreatitis ◽  
Classification Systems ◽  
Mortality And Morbidity ◽  
The Past ◽  
Edematous Pancreatitis ◽  
Acute Necrotic Collection

Background: Acute pancreatitis is one of the most common abdominal pathologies having variable outcome ranging from self limiting abdominal pain to high mortality and morbidity due to organ failure, over the past five decades, various classification systems have emerged to classify pancreatitis according to its severity , and the associated complications have emerged to classify acute pancreatitis and its various complications, such as Apache Scoring , Ct Severity , Modified Ct Severity ,Ransen  and Atlanta Classification. Objectives: We in our study will be classifying patients suffering from acute pancreatitis according to the revised Atlanta classification to divide them into interstitial edematous pancreatitis and necrotizing pancreatitis. The local complications will be classified according to CT imaging findings into acute necrotic collection, psuedocyst, acute necrotic collection and walled of necrosis. Organ failure will be assessed according to modified marshal scoring system into transient or persistent organ failure. Methodology: We will be carrying forward our study on   Siemens 16 slice computer tomography machine over a sample of 140 patients coming to the outpatient department of our hospital which will be followed by a routine clinical follow up of the patient to find out their prognosis. Results: Will be tabulated at the end of the study using SPSS version 26 software. Conclusion: The revised Atlanta classification for acute pancreatitis, in conjunction with the Modified Marshall Scoring System for organ failure, if found useful, in our series in improving the prognosis of the patients, then it can be incorporated in management.

scholarly journals Predicting the Severity of Acute Pancreatitis

2021 ◽  
Vol 26 (3) ◽  
pp. 168-175
Author(s):  
Song Yi Yu ◽  
Yun Chae Lee ◽  
Seong-Hun Kim ◽  
Seung Ok Lee
Keyword(s):  
Acute Pancreatitis ◽  
Organ Failure ◽  
Disease Severity ◽  
Severe Acute Pancreatitis ◽  
Mortality Risk ◽  
Large Scale ◽  
Time Of Death ◽  
Single Test ◽  
Serological Tests ◽  
Evaluation Measures

Acute pancreatitis has two mortality peaks, which occurs within the first 2 weeks due to organ failure and then weeks or months later as result of multi-organ failure and local complications. Although there have been several clinical and multidisciplinary evaluation measures, imaging tests, and serological tests proposed to forecast severe acute pancreatitis, there is still no single test available to reliably predict the disease severity and time of death. Future large-scale studies are required to develop an assessment scale that can accurately predict the prognosis and mortality risk of severe acute pancreatitis.

scholarly journals Increased circulating total bile acid levels were associated with organ failure in patients with acute pancreatitis

2020 ◽  
Author(s):  
Weiqin Li ◽  
Xiaochun Xie ◽  
Jie Dong ◽  
Guotao Lu ◽  
Kun Gao ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Regression Analysis ◽  
Bile Acid ◽  
Organ Failure ◽  
Pancreatic Necrosis ◽  
Early Stage ◽  
Multivariate Logistic Regression Analysis ◽  
Total Bile Acid ◽  
Percutaneous Catheter Drainage ◽  
Tertiary Center

Abstract Background: Recent studies have shown that bile acids (BAs) are closely related to metabolic and inflammatory diseases. Our study aimed to investigate whether circulating total bile acid (TBA) levels were associated with the severity of acute pancreatitis (AP).Methods: We retrospectively collected data on patients diagnosed with AP in a tertiary center from 01 January 2014 to 31 December 2016. Patients were divided into the high TBA (HTBA) group and the normal TBA (NTBA) group according to whether the highest TBA value (TBAmax) within 7 days after admission was ≥10μmol/L. The prognosis and complications, including death, organ failure (OF) and pancreatic necrosis, were compared between the two groups. Univariate and multivariate logistic regression analysis were used to evaluate the relationship between circulating TBA and organ failure in AP patients.Results: 293 patients were included in this study, of whom 18.43% (54/293) were in the HTBA group. The incidence of OF in the HTBA group was significantly higher than that in the NTBA group (59.3% vs 17.2%; P < 0.001), and the AP severity classification in the HTBA group was more serious than that in the NTBA group. The pancreatic necrosis rate, percutaneous catheter drainage (PCD) rate, open surgery rate and mortality rate in the HTBA group were higher than those in the NTBA group. Multivariate regression analysis showed that HTBA (odds ratio (OR), 4.894; P = 0.002) was an independent risk factor for AP complicated with OF. Conclusions: The increase of circulating TBA in early stage of AP is independently related to organ failure, which indicates the adverse prognosis of AP patients.

Postponed or immediate drainage of infected necrotizing pancreatitis (pointer): A multicenter randomized trial

Pancreatology ◽  
2021 ◽  
Vol 21 ◽  
pp. S10
Author(s):  
L. Boxhoorn ◽  
S.M. van Dijk ◽  
J. van Grinsven ◽  
R.C. Verdonk ◽  
M.A. Boermeester ◽  
...  
Keyword(s):  
Randomized Trial ◽  
Necrotizing Pancreatitis ◽  
Multicenter Randomized Trial

D-DIMER - AN ESSENTIAL MARKER IN SEVERITY PREDICTION OF ACUTE PANCREATITIS

2021 ◽  
pp. 78-82
Author(s):  
Mrinal Talukdar ◽  
Prashanth K R ◽  
Ratnadeep Paul
Keyword(s):  
Acute Pancreatitis ◽  
Organ Failure ◽  
Pancreatic Necrosis ◽  
Necrotizing Pancreatitis ◽  
Scoring Systems ◽  
Apache Ii ◽  
Receiver Operating Curve ◽  
Severity Prediction ◽  
Ranson Score ◽  
D Dimer

Introduction: Acute pancreatitis (AP) is characterized by a spectrum of symptoms, ranging from a local inammatory process to the more severe form (acute necrotizing pancreatitis) which is associated with a systemic inammatory response. The overall mortality rate of AP is between 5% and 15%, reaching 30 % in severe acute pancreatitis (SAP). Early optimized care may improve prognosis in patients with severe forms but it remains a challenge to identify these poor prognosis cases especially in the rst 48 hours. This study will evaluate the efcacy of serum D-Dimer in prediction of severity and outcome of acute pancreatitis. A prospective observati Methods: onal study of 60 patients presenting with AP was done at st st Silchar Medical College from 1 June 2017 to 31 May 2018. APACHE-II, Ranson criteria, and CT severity index (CTSI) of all patients were calculated,. D-Dimer was done for all patients. The patients were stratied into categories of severe pancreatitis, organ failure and pancreatic necrosis, as well as the number of deaths. The comparison of D-Dimer with other scoring systems was done by area under the receiver-operating curve (AUC) to predict severity, organ failure, necrosis, and death. Of the 60 patie Result: nts, 15 (25%) developed SAP, 12 (20%) Organ failure (OF), 22 (36.7%) pancreatic necrosis and 3 (5%) died. ROC curves were generated and following cut-off were selected for comparison of severity, organ failure, necrosis and death; Ranson ≥ 3, APACHE II ≥ 8, CTSI ≥ 4. Cut-off of D-Dimer value for severity, organ failure, necrosis and death are ≥1397µg/L, ≥1886µg/L, ≥1890µg/L and ≥5769µg/L respectively. The AUC of D-Dimer (0.914) in predicting severity of disease is similar to that of Apache 2 (0.958) and Ranson (0.899). CTSI (0.715) had lowest AUC among them. The AUC of D-Dimer (0.833) in predicting of organ failure of disease is similar to that of Ranson (0.908) and lower than Apache 2 (0.980). CTSI (0.715) had lowest AUC among them. The AUC of CTSI (0.892) in predicting the necrosis was higher than Apache 2 (0.590), Ranson score (0.578) system and D-Dimer. The AUC of D-Dimer (0.953) in predicting of mortality of disease is similar to that of Apache 2 (0.933), CTSI (0.953) and lower than Ranson score (0.816). Conclusion: D-Dimer is an easy tool for assessment of severity and prognosis of acute pancreatitis. CTSI is best for predicting pancreatic necrosis.

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