THE MULTIDISCIPLINARY APPROACH TO ACUTE NECROTIZING PANCREATITIS
INTRODUCTION: Acute pancreatitis is among the most common gastrointestinal diseases, and a major cause of hospitalization and morbidity. Gallstones and alcohol abuse are the most common causes of acute pancreatitis. Other etiologies include hypertriglyceridemia, medications, post- endoscopic retrograde cholangiopancreatography (ERCP), trauma, hypercalcemia, infections and toxins, anatomic anomalies, etc. In most cases acute pancreatitis is a mild self-limiting disease. However, up to 20% of patients develop severe pancreatitis with pancreatic necrosis, which possess high rates of multi-organ failure and mortality. Conservative management of acute necrotizing pancreatitis includes fluid resuscitation, nutritional support, and broad spectrum antibiotics for infected necrotic peripancreatic fluid collection (PFC). Indications for further invasive interventions include infected necrotic PFC and/or persistent severe symptoms due to mass effect. Current clinical management algorithms favor endoscopic ultrasound (EUS)-guided drainage of PFCs. In case of a large collection or extension to the paracolic gutters, a percutaneous drainage is indicated. Dual modalities (percutaneous together with endoscopic drainage) possess lower rates of pancreatic-cutaneous fistulas, shorter length of hospitalization and less endoscopic interventions. Direct endoscopic necrosectomy should be considered when the patient fails to improve despite endoscopic and percutaneous drainage. A multidisciplinary approach, which involves advanced endoscopists, interventional radiologists, pancreaticobiliary surgeons as well as nutrition and infectious disease specialists, is needed for the optimal management of severe necrotizing pancreatitis.
Medienart: |
Artikel |
---|
Erscheinungsjahr: |
2024 |
---|---|
Erschienen: |
2024 |
Enthalten in: |
Zur Gesamtaufnahme - volume:163 |
---|---|
Enthalten in: |
Harefuah - 163(2024), 3 vom: 21. März, Seite 156-163 |
Sprache: |
Hebräisch |
---|
Beteiligte Personen: |
Ritter, Einat [VerfasserIn] |
---|
Themen: |
---|
Anmerkungen: |
Date Completed 21.03.2024 Date Revised 21.03.2024 published: Print Citation Status MEDLINE |
---|
Förderinstitution / Projekttitel: |
|
---|
PPN (Katalog-ID): |
NLM369959558 |
---|
LEADER | 01000caa a22002652 4500 | ||
---|---|---|---|
001 | NLM369959558 | ||
003 | DE-627 | ||
005 | 20240322001126.0 | ||
007 | tu | ||
008 | 240320s2024 xx ||||| 00| ||heb c | ||
028 | 5 | 2 | |a pubmed24n1339.xml |
035 | |a (DE-627)NLM369959558 | ||
035 | |a (NLM)38506357 | ||
040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
041 | |a heb | ||
100 | 1 | |a Ritter, Einat |e verfasserin |4 aut | |
245 | 1 | 4 | |a THE MULTIDISCIPLINARY APPROACH TO ACUTE NECROTIZING PANCREATITIS |
264 | 1 | |c 2024 | |
336 | |a Text |b txt |2 rdacontent | ||
337 | |a ohne Hilfsmittel zu benutzen |b n |2 rdamedia | ||
338 | |a Band |b nc |2 rdacarrier | ||
500 | |a Date Completed 21.03.2024 | ||
500 | |a Date Revised 21.03.2024 | ||
500 | |a published: Print | ||
500 | |a Citation Status MEDLINE | ||
520 | |a INTRODUCTION: Acute pancreatitis is among the most common gastrointestinal diseases, and a major cause of hospitalization and morbidity. Gallstones and alcohol abuse are the most common causes of acute pancreatitis. Other etiologies include hypertriglyceridemia, medications, post- endoscopic retrograde cholangiopancreatography (ERCP), trauma, hypercalcemia, infections and toxins, anatomic anomalies, etc. In most cases acute pancreatitis is a mild self-limiting disease. However, up to 20% of patients develop severe pancreatitis with pancreatic necrosis, which possess high rates of multi-organ failure and mortality. Conservative management of acute necrotizing pancreatitis includes fluid resuscitation, nutritional support, and broad spectrum antibiotics for infected necrotic peripancreatic fluid collection (PFC). Indications for further invasive interventions include infected necrotic PFC and/or persistent severe symptoms due to mass effect. Current clinical management algorithms favor endoscopic ultrasound (EUS)-guided drainage of PFCs. In case of a large collection or extension to the paracolic gutters, a percutaneous drainage is indicated. Dual modalities (percutaneous together with endoscopic drainage) possess lower rates of pancreatic-cutaneous fistulas, shorter length of hospitalization and less endoscopic interventions. Direct endoscopic necrosectomy should be considered when the patient fails to improve despite endoscopic and percutaneous drainage. A multidisciplinary approach, which involves advanced endoscopists, interventional radiologists, pancreaticobiliary surgeons as well as nutrition and infectious disease specialists, is needed for the optimal management of severe necrotizing pancreatitis | ||
650 | 4 | |a English Abstract | |
650 | 4 | |a Journal Article | |
650 | 7 | |a Anti-Bacterial Agents |2 NLM | |
700 | 1 | |a Shibolet, Oren |e verfasserin |4 aut | |
700 | 1 | |a Kessner, Rivka |e verfasserin |4 aut | |
700 | 1 | |a Lubezky, Nir |e verfasserin |4 aut | |
700 | 1 | |a Ben Ami Shor, Dana |e verfasserin |4 aut | |
773 | 0 | 8 | |i Enthalten in |t Harefuah |d 1946 |g 163(2024), 3 vom: 21. März, Seite 156-163 |w (DE-627)NLM000070491 |x 0017-7768 |7 nnns |
773 | 1 | 8 | |g volume:163 |g year:2024 |g number:3 |g day:21 |g month:03 |g pages:156-163 |
912 | |a GBV_USEFLAG_A | ||
912 | |a GBV_NLM | ||
951 | |a AR | ||
952 | |d 163 |j 2024 |e 3 |b 21 |c 03 |h 156-163 |