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Hamesch K, Hollenbach M, Guilabert L, Lahmer T, Koch A. Practical management of severe acute pancreatitis. Eur J Intern Med 2025; 133:1-13. [PMID: 39613703 DOI: 10.1016/j.ejim.2024.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Revised: 10/29/2024] [Accepted: 10/30/2024] [Indexed: 12/01/2024]
Abstract
Acute pancreatitis (AP) represents one of the most common reasons for hospital admission and intensive care treatment in internal medicine. The incidence of AP is increasing, posing significant financial burden on healthcare systems due to the necessity for frequent medical interventions. Severe acute pancreatitis (SAP) is a potentially life-threatening condition with substantial morbidity and mortality. The management of SAP requires prolonged hospitalization and the expertise of a multidisciplinary team, comprising emergency physicians, intensivists, internists, gastroenterologists, visceral surgeons, and experts in nutrition, infectious disease, endoscopy, as well as diagnostic and interventional radiology. Effective management and beneficial patient outcomes depend on continuous interdisciplinary collaboration. This review synthesizes recent evidence guiding the practical management of SAP, with a particular focus on emergency and intensive care settings. Both established as well as new diagnostic and therapeutic paradigms are highlighted, including workup, risk stratification, fluid management, analgesia, nutrition, organ support, imaging modalities and their timing, along with anti-infective strategies. Furthermore, the review explores interventions for local and vascular complications of SAP, with particular attention to the indications, timing and selection between endoscopic (both endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS)), percutaneous and surgical approaches. Similarly, the management of biliary AP due to obstructive gallstones, including the imaging, timing of ERCP and cholecystectomy, are discussed. By integrating new evidence with relevant guidance for everyday clinical practice, this review aims to enhance the interdisciplinary approach essential for improving outcomes in SAP management.
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Affiliation(s)
- Karim Hamesch
- Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany
| | - Marcus Hollenbach
- Department of Gastroenterology, Endocrinology, Infectious Diseases, University of Marburg UKGM, Marburg, Germany
| | - Lucía Guilabert
- Department of Gastroenterology, Dr. Balmis General University Hospital- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Tobias Lahmer
- Clinic for Internal Medicine II, Klinikum rechts der Isar der Technischen, University of Munich, Munich, Germany
| | - Alexander Koch
- Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany.
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Yu NJ, Li XH, Liu C, Chen C, Xu WH, Chen C, Chen Y, Liu TT, Chen TW, Zhang XM. Radiomics models of contrast-enhanced computed tomography for predicting the activity and prognosis of acute pancreatitis. Insights Imaging 2024; 15:158. [PMID: 38902394 PMCID: PMC11190132 DOI: 10.1186/s13244-024-01738-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 06/02/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND The modified pancreatitis activity scoring system (mPASS) was proposed to assess the activity of acute pancreatitis (AP) while it doesn't include indicators that directly reflect pathophysiology processes and imaging characteristics. OBJECTIVES To determine the threshold of admission mPASS and investigate radiomics and laboratory parameters to construct a model to predict the activity of AP. METHODS AP inpatients at institution 1 were randomly divided into training and validation groups based on a 5:5 ratio. AP inpatients at Institution 2 were served as test group. The cutoff value of admission mPASS scores in predicting severe AP was selected to divide patients into high and low level of disease activity group. LASSO was used in screening features. Multivariable logistic regression was used to develop radiomics model. Meaningful laboratory parameters were used to construct combined model. RESULTS There were 234 (48 years ± 10, 155 men) and 101 (48 years ± 11, 69 men) patients in two institutions. The threshold of admission mPASS score was 112.5 in severe AP prediction. The AUC of the radiomics model was 0.79, 0.72, and 0.76 and that of the combined model incorporating rad-score and white blood cell were 0.84, 0.77, and 0.80 in three groups for activity prediction. The AUC of the combined model in predicting disease without remission was 0.74. CONCLUSIONS The threshold of admission mPASS was 112.5 in predicting severe AP. The model based on CECT radiomics has the ability to predict AP activity. Its ability to predict disease without remission is comparable to mPASS. CRITICAL RELEVANCE STATEMENT This work is the first attempt to assess the activity of acute pancreatitis using contrast-enhanced CT radiomics and laboratory parameters. The model provides a new method to predict the activity and prognosis of AP, which could contribute to further management. KEY POINTS Radiomics features and laboratory parameters are associated with the activity of acute pancreatitis. The combined model provides a new method to predict the activity and prognosis of AP. The ability of the combined model is comparable to the modified Pancreatitis Activity Scoring System.
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Affiliation(s)
- Ning Jun Yu
- Medical Imaging Key Laboratory of Sichuan Province, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, No.1 South Maoyuan Road, Nanchong, 637001, Sichuan, China
| | - Xing Hui Li
- Medical Imaging Key Laboratory of Sichuan Province, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, No.1 South Maoyuan Road, Nanchong, 637001, Sichuan, China
| | - Chao Liu
- Medical Imaging Key Laboratory of Sichuan Province, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, No.1 South Maoyuan Road, Nanchong, 637001, Sichuan, China
| | - Chao Chen
- Department of Radiology, The Second Clinical Medical College of North Sichuan Medical College Nanchong Central Hospital, Nanchong, Sichuan, China
| | - Wen Han Xu
- Medical Imaging Key Laboratory of Sichuan Province, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, No.1 South Maoyuan Road, Nanchong, 637001, Sichuan, China
| | - Chao Chen
- Medical Imaging Key Laboratory of Sichuan Province, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, No.1 South Maoyuan Road, Nanchong, 637001, Sichuan, China
| | - Yong Chen
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ting Ting Liu
- Medical Imaging Key Laboratory of Sichuan Province, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, No.1 South Maoyuan Road, Nanchong, 637001, Sichuan, China
| | - Tian Wu Chen
- Medical Imaging Key Laboratory of Sichuan Province, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, No.1 South Maoyuan Road, Nanchong, 637001, Sichuan, China
| | - Xiao Ming Zhang
- Medical Imaging Key Laboratory of Sichuan Province, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, No.1 South Maoyuan Road, Nanchong, 637001, Sichuan, China.
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Song Y, Lee SH. Recent Treatment Strategies for Acute Pancreatitis. J Clin Med 2024; 13:978. [PMID: 38398290 PMCID: PMC10889262 DOI: 10.3390/jcm13040978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/26/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
Acute pancreatitis (AP) is a leading gastrointestinal disease that causes hospitalization. Initial management in the first 72 h after the diagnosis of AP is pivotal, which can influence the clinical outcomes of the disease. Initial management, including assessment of disease severity, fluid resuscitation, pain control, nutritional support, antibiotic use, and endoscopic retrograde cholangiopancreatography (ERCP) in gallstone pancreatitis, plays a fundamental role in AP treatment. Recent updates for fluid resuscitation, including treatment goals, the type, rate, volume, and duration, have triggered a paradigm shift from aggressive hydration with normal saline to goal-directed and non-aggressive hydration with lactated Ringer's solution. Evidence of the clinical benefit of early enteral feeding is becoming definitive. The routine use of prophylactic antibiotics is generally limited, and the procalcitonin-based algorithm of antibiotic use has recently been investigated to distinguish between inflammation and infection in patients with AP. Although urgent ERCP (within 24 h) should be performed for patients with gallstone pancreatitis and cholangitis, urgent ERCP is not indicated in patients without cholangitis. The management approach for patients with local complications of AP, particularly those with infected necrotizing pancreatitis, is discussed in detail, including indications, timing, anatomical considerations, and selection of intervention methods. Furthermore, convalescent treatment, including cholecystectomy in gallstone pancreatitis, lipid-lowering medications in hypertriglyceridemia-induced AP, and alcohol intervention in alcoholic pancreatitis, is also important for improving the prognosis and preventing recurrence in patients with AP. This review focuses on recent updates on the initial and convalescent management strategies for AP.
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Affiliation(s)
| | - Sang-Hoon Lee
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul 05030, Republic of Korea;
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4
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Palumbo R, Schuster KM. Contemporary management of acute pancreatitis: What you need to know. J Trauma Acute Care Surg 2024; 96:156-165. [PMID: 37722072 DOI: 10.1097/ta.0000000000004143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
ABSTRACT Acute pancreatitis and management of its complications is a common consult for the acute care surgeon. With the ongoing development of both operative and endoscopic treatment modalities, management recommendations continue to evolve. We describe the current diagnostic and treatment guidelines for acute pancreatitis through the lens of acute care surgery. Topics, including optimal nutrition, timing of cholecystectomy in gallstone pancreatitis, and the management of peripancreatic fluid collections, are discussed. Although the management severe acute pancreatitis can include advanced interventional modalities including endoscopic, percutaneous, and surgical debridement, the initial management of acute pancreatitis includes fluid resuscitation, early enteral nutrition, and close monitoring with consideration of cross-sectional imaging and antibiotics in the setting of suspected superimposed infection. Several scoring systems including the Revised Atlanta Criteria, the Bedside Index for Severity in Acute Pancreatitis score, and the American Association for the Surgery of Trauma grade have been devised to classify and predict the development of the severe acute pancreatitis. In biliary pancreatitis, cholecystectomy prior to discharge is recommended in mild disease and within 8 weeks of necrotizing pancreatitis, while early peripancreatic fluid collections should be managed without intervention. Underlying infection or ongoing symptoms warrant delayed intervention with technique selection dependent on local expertise, anatomic location of the fluid collection, and the specific clinical scenario. Landmark trials have shifted therapy from maximally invasive necrosectomy to more minimally invasive step-up approaches. The acute care surgeon should maintain a skill set that includes these minimally invasive techniques to successfully manage these patients. Overall, the management of acute pancreatitis for the acute care surgeon requires a strong understanding of both the clinical decisions and the options for intervention should this be necessary.
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Affiliation(s)
- Rachael Palumbo
- From the Department of Surgery, Yale School of Medicine, New Haven, Connecticut
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Song LJ, Xiao B. Acute pancreatitis: Structured report template of magnetic resonance imaging. World J Radiol 2023; 15:157-169. [PMID: 37424735 PMCID: PMC10324496 DOI: 10.4329/wjr.v15.i6.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/25/2023] [Accepted: 06/16/2023] [Indexed: 06/28/2023] Open
Abstract
Acute pancreatitis (AP) is a common acute abdomen disease of the digestive system. It has a potentially fatal risk because of its variable severity and various complications. With the widespread application of the Revised Atlanta Classification, new requirements for AP imaging reports are introduced. Experts in abdominal radiology and pancreatology in the United States published the first structured computed tomography reporting template for AP in 2020. However, there is no corresponding structured magnetic resonance imaging (MRI) reporting template globally. Therefore, this article focuses on the structured MRI report of AP images from our pancreatitis imaging center, which is intended to improve the systematic understanding of this disease and standardize the writing of MRI structured reports. In the meantime, we aim to promote the clinical diagnosis and assessment of MRI efficacy for AP and its multiple complications. It is further intended to facilitate academic exchanges and scientific research between different medical centers.
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Affiliation(s)
- Ling-Ji Song
- Department of Radiology, Sichuan Key Laboratory of Medical Imaging, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Bo Xiao
- Department of Radiology, Sichuan Key Laboratory of Medical Imaging, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
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6
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Muñoz D, Medina R, Botache WF, Arrieta RE. Pancreatitis aguda: puntos clave. Revisión argumentativa de la literatura. REVISTA COLOMBIANA DE CIRUGÍA 2023. [DOI: 10.30944/20117582.2206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Introducción. La pancreatitis aguda es una condición gastrointestinal común que se asocia a una importante morbimortalidad. Se estima que su incidencia es de 34 por cada 100.000 habitantes, afecta principalmente a adultos a partir de la sexta década de la vida y en nuestra región es debida en la mayoría de los casos a cálculos biliares.
Métodos. Se hizo una revisión de los aspectos fundamentales de esta patología, común y potencialmente mortal.
Resultados. El diagnóstico requiere del hallazgo de manifestaciones clínicas, aumento de las enzimas pancreáticas en suero y, en ocasiones, el uso de imágenes diagnósticas. Se puede clasificar en leve, moderada y severa, lo cual es fundamental para determinar la necesidad de tratamiento y vigilancia en una unidad de cuidados intensivos.
Conclusión. En la actualidad los pilares de manejo de la pancreatitis aguda son la terapia temprana con líquidos, tratamiento del dolor, inicio precoz de la vía oral y resolución del factor etiológico desencadenante. En presencia de complicaciones o un curso severo de enfermedad, pueden requerirse manejo antibiótico e intervenciones invasivas.
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7
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Lee SH, Choe JW, Cheon YK, Choi M, Jung MK, Jang DK, Jo JH, Lee JM, Kim EJ, Han SY, Choi YH, Seo HI, Lee DH, Lee HS. Revised Clinical Practice Guidelines of the Korean Pancreatobiliary Association for Acute Pancreatitis. Gut Liver 2023; 17:34-48. [PMID: 35975642 PMCID: PMC9840919 DOI: 10.5009/gnl220108] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/27/2022] [Accepted: 04/29/2022] [Indexed: 02/01/2023] Open
Abstract
Acute pancreatitis can range from a mild, self-limiting disease requiring no more than supportive care, to severe disease with life-threatening complications. With the goal of providing a recommendation framework for clinicians to manage acute pancreatitis, and to contribute to improvements in national health care, the Korean Pancreatobiliary Association (KPBA) established the Korean guidelines for acute pancreatitis management in 2013. However, many challenging issues exist which often lead to differences in clinical practices. In addition, with newly obtained evidence regarding acute pancreatitis, there have been great changes in recent knowledge and information regarding this disorder. Therefore, the KPBA committee underwent an extensive revision of the guidelines. The revised guidelines were developed using the Delphi method, and the main topics of the guidelines include the following: diagnosis, severity assessment, initial treatment, nutritional support, convalescent treatment, and the treatment of local complications and necrotizing pancreatitis. Specific recommendations are presented, along with the evidence levels and recommendation grades.
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Affiliation(s)
- Sang Hyub Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Wan Choe
- Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Young Koog Cheon
- Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Miyoung Choi
- Division of Health Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Min Kyu Jung
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Dong Kee Jang
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Hyun Jo
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Min Lee
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Korea
| | - Eui Joo Kim
- Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Sung Yong Han
- Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Young Hoon Choi
- Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyung-Il Seo
- Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Dong Ho Lee
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hong Sik Lee
- Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea,Corresponding AuthorHong Sik Lee, ORCIDhttps://orcid.org/0000-0001-9726-5416, E-mail
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8
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Olpin JD, Griffith A. Imaging of Acute Pancreatitis According to the Revised Atlanta Classification. CURRENT RADIOLOGY REPORTS 2022. [DOI: 10.1007/s40134-022-00402-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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9
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Jegatheeswaran S, Finch LM, Siriwardena MC, Siriwardena AK. The terminology of the 2012 Atlanta consensus conference on post-inflammatory collections after acute pancreatitis: An assessment of utilization in practice. Hepatobiliary Pancreat Dis Int 2022; 21:508-510. [PMID: 34789411 DOI: 10.1016/j.hbpd.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 10/26/2021] [Indexed: 02/05/2023]
Affiliation(s)
- Santhalingam Jegatheeswaran
- Regional Hepato-Pancreato-Biliary Surgery Unit, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK
| | - Louise M Finch
- Regional Hepato-Pancreato-Biliary Surgery Unit, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK
| | | | - Ajith K Siriwardena
- Regional Hepato-Pancreato-Biliary Surgery Unit, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK; Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
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10
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Bhakta D, de Latour R, Khanna L. Management of pancreatic fluid collections. Transl Gastroenterol Hepatol 2022; 7:17. [PMID: 35548474 PMCID: PMC9081921 DOI: 10.21037/tgh-2020-06] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/10/2021] [Indexed: 12/28/2023] Open
Abstract
Pancreatic fluid collections often develop as a complication of acute pancreatitis but can be seen in a variety of conditions including chronic pancreatitis, trauma, malignancy or post-operatively. It is important to classify a pancreatic fluid collection in order to optimize treatment strategies and management. Most interventions are targeted towards the management of delayed complications of pancreatitis, including pancreatic pseudocysts and walled-off necrosis (WON), which often develop days to weeks after the initial episode of pancreatitis. Surgical, percutaneous, and endoscopic interventions are all possible methods for treatment of pancreatic fluid collections, however endoscopic drainage with endoscopic ultrasound has become first-line. Advances within endoscopic drainage strategies have also led to innovative changes in the specific stents used for treatment, with possible options including double pigtail plastic stents, fully covered self-expanding metal stents and lumen-apposing metal stents (LAMS).
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Affiliation(s)
- Dimpal Bhakta
- New York University School of Medicine, New York, USA
| | | | - Lauren Khanna
- New York University School of Medicine, New York, USA
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11
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Zaafouri H, Dawood A, Mesbahi M, Alotaibi T, Ahmadi MAL, Aiat M. Descending colon fistula: Unusual complication of severe acute pancreatitis a case report. Ann Med Surg (Lond) 2022; 75:103426. [PMID: 35386763 PMCID: PMC8977942 DOI: 10.1016/j.amsu.2022.103426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 02/17/2022] [Accepted: 02/27/2022] [Indexed: 02/08/2023] Open
Abstract
Introduction The incidence of colonic complications from acute pancreatitis (AP) and severe AP are 3.3% and 15%, respectively. We report a case of descending colon fistula secondary to severe AP and its management. Case presentation We report a case of a 35-year-old male hospitalized in our department for severe acute pancreatitis (grade E of Balthazar classification). Initially, the evolution was favorable under medical management. Two months later, he was readmitted for infection of the necrosis with a descending colon fistula. As we did not have the possibility of performing a CT scan drainage, our plan was to do surgical drainage under general anesthesia. Conclusion The colonic involvement following AP or severe AP is rare and difficult to diagnoses. Conservative treatment when some conditions are available should be the best choice; it is associated with lower risk of morbidity and mortality.
Knowledge about colonic complications from AP has been limited to few case reports. Thus diagnostic and management dilemmas continue to persist. The clinical presentation can be variable. Nonspecific and could occur quite late in the disease process. For the management. There are no evidence-based guidelines.
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Affiliation(s)
- Haithem Zaafouri
- Department of General Surgery, King Abdul Aziz Hospital, Jeddah, Saudi Arabia
| | - Atif Dawood
- Department of General Surgery, King Abdul Aziz Hospital, Jeddah, Saudi Arabia
| | - Meriam Mesbahi
- General Surgery Department, Habib Thameur Hospital, Tunis, Tunisia
| | - Turki Alotaibi
- Department of General Surgery, King Abdul Aziz Hospital, Jeddah, Saudi Arabia
| | - Mourouj A L Ahmadi
- Department of General Surgery, King Abdul Aziz Hospital, Jeddah, Saudi Arabia
| | - Maged Aiat
- Department of General Surgery, King Abdul Aziz Hospital, Jeddah, Saudi Arabia
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12
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Zaafouri H, Dawood A, Mesbahi M, Alotaibi T, Ahmadi MA, Aiat M. Descending colon fistula: Unusual complication of severe acute pancreatitis a case report. Ann Med Surg (Lond) 2022. [DOI: https://doi.org/10.1016/j.amsu.2022.103426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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13
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Planz V, Galgano SJ. Percutaneous biopsy and drainage of the pancreas. Abdom Radiol (NY) 2022; 47:2584-2603. [PMID: 34410433 PMCID: PMC8375282 DOI: 10.1007/s00261-021-03244-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/05/2021] [Accepted: 08/07/2021] [Indexed: 01/18/2023]
Abstract
Percutaneous pancreatic interventions performed by abdominal radiologists play important diagnostic and therapeutic roles in the management of a wide range of pancreatic pathology. While often performed with endoscopy, pancreatic mass biopsy obtained via a percutaneous approach may serve as the only feasible option for diagnosis in patients with post-surgical anatomy, severe cardiopulmonary conditions, or prior non-diagnostic endoscopic attempts. Biopsy of pancreatic transplants are commonly performed percutaneously due to inaccessible location of the allograft by endoscopy, usually in the right lower quadrant or pelvis. Percutaneous drainage of collections in acute pancreatitis is primarily indicated for infection with clinical deterioration and may be performed alone or in combination with endoscopic drainage. Post-surgical pancreatic collections related to pancreatic duct fistula or leak also often warrant therapeutic percutaneous drainage. Knowledge of appropriate indications, strategies of approach, technique, and complications associated with these procedures is critical for a successful clinical practice.
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Affiliation(s)
- Virginia Planz
- Department of Radiology, Vanderbilt University Medical Center, Nashville, TN USA
| | - Samuel J. Galgano
- Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JT J779, Birmingham, AL 35249 USA
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14
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Johnson TA, Vinayak A, Heo JY, Green TA. Gastrointestinal Intramural Pancreatic Pseudocysts in a Dog: A Case Report and Human Literature Review. J Am Anim Hosp Assoc 2021; 58:96-104. [PMID: 34606594 DOI: 10.5326/jaaha-ms-6992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2020] [Indexed: 11/11/2022]
Abstract
A 9.5 yr old Yorkshire terrier presented with chronic intermittent vomiting and lethargy of 1.5 yr duration that progressed to generalized weakness. Insulin:glucose ratio was consistent with an insulinoma. Triple-phase computed tomography revealed a mid-body pancreatic nodule. The mid-body pancreatic nodule was enucleated; histopathology was consistent with an insulinoma. Two weeks after the operation, the dog presented for anorexia and diarrhea. Abdominal ultrasound revealed a thick-walled cystic lesion along the dorsal stomach wall. An intramural gastric pseudocyst was diagnosed via exploratory laparotomy and intraoperative gastroscopy. Comparison of amylase and lipase levels of the cystic fluid with that of concurrent blood serum samples confirmed the lesion was of pancreatic pseudocyst origin. The gastric pseudocyst was omentalized. Two weeks after the operation, the dog re-presented for anorexia, regurgitation, and diarrhea. An intramural duodenal pseudocyst was identified and treated with a duodenal resection and anastomosis. The dog has remained asymptomatic and recurrence free based on serial abdominal ultrasounds 22 mo following insulinoma removal. To our knowledge, this phenomenon of pancreatic pseudocysts forming in organs other than the pancreas has not been reported in dogs. This case report and comprehensive human literature review purpose is to raise awareness of this disease process in dogs.
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Rahnemai-Azar AA, Sutter C, Hayat U, Glessing B, Ammori J, Tavri S. Multidisciplinary Management of Complicated Pancreatitis: What Every Interventional Radiologist Should Know. AJR Am J Roentgenol 2021; 217:921-932. [PMID: 33470838 DOI: 10.2214/ajr.20.25168] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Management of acute pancreatitis is challenging in the presence of local complications that include pancreatic and peripancreatic collections and vascular complications. This review, targeted for interventional radiologists, describes minimally invasive endoscopic, image-guided percutaneous, and surgical procedures for management of complicated pancreatitis and provides insight into the procedures' algorithmic application. Local complications are optimally managed in a multidisciplinary team setting that includes advanced endoscopists; pancreatic surgeons; diagnostic and interventional radiologists; and specialists in infectious disease, nutrition, and critical care medicine. Large symptomatic or complicated sterile collections and secondary infected collections warrant drainage or débridement. The drainage is usually delayed for 4-6 weeks unless clinical deterioration warrants early intervention. If collections are accessible by endoscopy, endoscopic procedures are preferred to avoid pancreaticocutaneous fistulas. Image-guided percutaneous drainage is indicated for symptomatic collections that are not accessible for endoscopic drainage or that present in the acute setting before developing a mature wall. Peripancreatic arterial pseudoaneurysms should be embolized before necrosectomy procedures to prevent potentially life-threatening hemorrhage. Surgical procedures are reserved for symptomatic collections that persist despite endoscopic or interventional drainage attempts. Understanding these procedures facilitates their integration by interventional radiologists into the complex longitudinal care of patients with complicated pancreatitis.
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Affiliation(s)
- Amir Ata Rahnemai-Azar
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Ave, Cleveland, OH 44106
| | - Christopher Sutter
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Ave, Cleveland, OH 44106
| | - Umar Hayat
- Department of Medicine, Division of Gastroenterology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Brooke Glessing
- Department of Medicine, Division of Gastroenterology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - John Ammori
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Sidhartha Tavri
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Ave, Cleveland, OH 44106
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16
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Gupta V, Singh Sodha V, Kumar N, Gupta V, Pate R, Chandra A. Missed pancreatic injury in patients undergoing conservative management of blunt abdominal trauma: Causes, sequelae and management. Turk J Surg 2021; 37:286-293. [DOI: 10.47717/turkjsurg.2021.5425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 07/16/2021] [Indexed: 11/23/2022]
Abstract
Objective: Pancreas is a less commonly injured organ in blunt abdominal trauma. This study aimed to analyze the management and outcomes of patients in whom the pancreatic injury was missed during the initial evaluation of blunt abdominal trauma.
Material and Methods: We retrospectively (2009-2019) analyzed the details and outcome of patients who underwent conservative management of blunt abdominal trauma, where the diagnosis of pancreatic injury was missed for at least 72 hours following trauma.
Results: A total of 31 patients with missed pancreatic injury were identified. All patients were hemodynamically stable following trauma and most (21) were initially assessed only by an ultrasound. A delayed diagnosis of pancreatic injury was made at a mean of 28 (4 to 60) days after trauma when patients developed abdominal pain (31), distension (18), fever (10) or vomiting (8). On repeat imaging, 18 (58.1%) patients had high grade pancreatic injuries including complete transection or pancreatic duct injury. Seven (22.5%) patients were managed conservatively, seventeen (54.8%) underwent percutaneous drainage of intra-abdominal collections, seven (22.5%) underwent endoscopic or surgical drainage procedure for symptomatic pseudocyst. Eleven (35.4%) patients needed readmissions to manage recurrent pancreatitis, intra-abdominal abscess and pancreatic fistula. Three patients required pancreatic duct stenting for pancreatic fistula. There was no mortality.
Conclusion: Pancreatic injury may be missed in patients who remain hemodynamically stable with minimal clinical symptoms after abdominal trauma, especially if screened only by an ultrasound. In our series, there was significant morbidity of missed pancreatic injury.
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17
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Oh CH, Lee JK, Song TJ, Park JS, Lee JM, Son JH, Jang DK, Choi M, Byeon JS, Lee IS, Lee ST, Choi HS, Kim HG, Chun HJ, Park CG, Cho JY. Clinical Practice Guidelines for the Endoscopic Management of Peripancreatic Fluid Collections. Clin Endosc 2021; 54:505-521. [PMID: 34305047 PMCID: PMC8357592 DOI: 10.5946/ce.2021.185] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 07/20/2021] [Indexed: 12/13/2022] Open
Abstract
Endoscopic ultrasonography-guided intervention has gradually become a standard treatment for peripancreatic fluid collections (PFCs). However, it is difficult to popularize the procedure in Korea because of restrictions on insurance claims regarding the use of endoscopic accessories, as well as the lack of standardized Korean clinical practice guidelines. The Korean Society of Gastrointestinal Endoscopy (KSGE) appointed a Task Force to develope medical guidelines by referring to the manual for clinical practice guidelines development prepared by the National Evidence-Based Healthcare Collaborating Agency. Previous studies on PFCs were searched, and certain studies were selected with the help of experts. Then, a set of key questions was selected, and treatment guidelines were systematically reviewed. Answers to these questions and recommendations were selected via peer review. This guideline discusses endoscopic management of PFCs and makes recommendations on Indications for the procedure, pre-procedural preparations, optimal approach for drainage, procedural considerations (e.g., types of stent, advantages and disadvantages of plastic and metal stents, and accessories), adverse events of endoscopic intervention, and procedural quality issues. This guideline was reviewed by external experts and suggests best practices recommended based on the evidence available at the time of preparation. This will be revised as necessary to address advances and changes in technology and evidence obtained in clinical practice and future studies.
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Affiliation(s)
- Chi Hyuk Oh
- Division of Gastroenterology, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Korea
| | - Jun Kyu Lee
- Division of Gastroenterology, Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Tae Jun Song
- Division of Gastroenterology, Department of Internal Medicine, Asan Medical Center, Seoul, Korea
| | - Jin-Seok Park
- Division of Gastroenterology, Department of Internal Medicine, Inha University Hospital, Incheon, Korea
| | - Jae Min Lee
- Division of Gastroenterology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Jun Hyuk Son
- Division of Gastroenterology, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Dong Kee Jang
- Division of Gastroenterology, Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Miyoung Choi
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Jeong-Sik Byeon
- Division of Gastroenterology, Department of Internal Medicine, Asan Medical Center, Seoul, Korea
| | - In Seok Lee
- Division of Gastroenterology, Department of Internal Medicine, The Catholic University of Korea Seoul ST. Mary's Hospital, Seoul, Korea
| | - Soo Teik Lee
- Division of Gastroenterology, Department of Internal Medicine, Jeonbuk National University Hospital, Jeonju, Korea
| | - Ho Soon Choi
- Division of Gastroenterology, Department of Internal Medicine, Hanyang University Seoul Hospital, Seoul, Korea
| | - Ho Gak Kim
- Division of Gastroenterology, Department of Internal Medicine, Daegu Catholic University Hospital, Daegu, Korea
| | - Hoon Jai Chun
- Division of Gastroenterology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Chan Guk Park
- Division of Gastroenterology, Department of Internal Medicine, Chosun University Hospital, Gwangju, Korea
| | - Joo Young Cho
- Division of Gastroenterology, Department of Internal Medicine, Cha University Bundang Medical Center, Seongnam, Korea
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18
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Oh CH, Song TJ, Lee JK, Park JS, Lee JM, Son JH, Jang DK, Choi M, Byeon JS, Lee IS, Lee ST, Choi HS, Kim HG, Chun HJ, Park CG, Cho JY. Clinical Practice Guidelines for the Endoscopic Management of Peripancreatic Fluid Collections. Gut Liver 2021; 15:677-693. [PMID: 34305047 PMCID: PMC8444102 DOI: 10.5009/gnl210001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 04/26/2021] [Accepted: 05/12/2021] [Indexed: 11/21/2022] Open
Abstract
Endoscopic ultrasonography-guided intervention has gradually become a standard treatment for peripancreatic fluid collections (PFCs). However, it is difficult to popularize the procedure in Korea because of restrictions on insurance claims regarding the use of endoscopic accessories, as well as the lack of standardized Korean clinical practice guidelines. The Korean Society of Gastrointestinal Endoscopy appointed a Task Force to develop medical guidelines by referring to the manual for clinical practice guidelines development prepared by the National Evidence-Based Healthcare Collaborating Agency. Previous studies on PFCs were searched, and certain studies were selected with the help of experts. Then, a set of key questions was selected, and treatment guidelines were systematically reviewed. Answers to these questions and recommendations were selected via peer review. This guideline discusses endoscopic management of PFCs and makes recommendations on Indications for the procedure, pre-procedural preparations, optimal approach for drainage, procedural considerations (e.g., types of stent, advantages and disadvantages of plastic and metal stents, and accessories), adverse events of endoscopic intervention, and procedural quality issues. This guideline was reviewed by external experts and suggests best practices recommended based on the evidence available at the time of preparation. This will be revised as necessary to address advances and changes in technology and evidence obtained in clinical practice and future studies. (Gut Liver 2021;15:-693)
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Affiliation(s)
- Chi Hyuk Oh
- Division of Gastroenterology, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Kore
| | - Tae Jun Song
- Division of Gastroenterology, Department of Internal Medicine, Asan Medical Center, Seoul, Korea
| | - Jun Kyu Lee
- Division of Gastroenterology, Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Jin-Seok Park
- Division of Gastroenterology, Department of Internal Medicine, Inha University Hospital, Incheon, Korea
| | - Jae Min Lee
- Division of Gastroenterology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Jun Hyuk Son
- Division of Gastroenterology, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Dong Kee Jang
- Division of Gastroenterology, Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Miyoung Choi
- National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
| | - Jeong-Sik Byeon
- Division of Gastroenterology, Department of Internal Medicine, Asan Medical Center, Seoul, Korea
| | - In Seok Lee
- Division of Gastroenterology, Department of Internal Medicine, The Catholic University of Korea Seoul St. Mary's Hospital, Seoul, Korea
| | - Soo Teik Lee
- Division of Gastroenterology, Department of Internal Medicine, Jeonbuk National University Hospital, Jeonju, Korea
| | | | - Ho Gak Kim
- Division of Gastroenterology, Department of Internal Medicine, Daegu Catholic University Hospital, Daegu, Korea
| | - Hoon Jai Chun
- Division of Gastroenterology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Chan Guk Park
- Division of Gastroenterology, Department of Internal Medicine, Chosun University Hospital, Gwangju, Korea
| | - Joo Young Cho
- Division of Gastroenterology, Department of Internal Medicine, CHA University Bundang Medical Center, Seongnam, Korea
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19
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Pancreatic Disorders of Pregnancy. Clin Obstet Gynecol 2021; 63:226-242. [PMID: 31789887 DOI: 10.1097/grf.0000000000000503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The pancreas is an organ with both exocrine and endocrine functions that has a vital role in both digestion as well as glucose metabolism. Although pancreatic dysfunction and disorders are rare in pregnancy, they are becoming increasingly more common. Recognition of these disorders and understanding how they can affect pregnancy is imperative to allow for proper management. We provide an overview of the most common pancreatic disorders that are seen in pregnancy.
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20
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Current State of Imaging of Pediatric Pancreatitis: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2021; 217:265-277. [PMID: 33728974 DOI: 10.2214/ajr.21.25508] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Pancreatitis is as common in children as it is in adults, though causes and accepted imaging strategies differ in children. In this narrative review we discuss the epidemiology of childhood pancreatitis and key imaging features for pediatric acute, acute recurrent, and chronic pancreatitis. We rely heavily on our collective experience in discussing advantages and disadvantages of different imaging modalities; practical tips for optimization of ultrasound, CT, and MRI with MRCP in children; and image interpretation pearls. Challenges and considerations unique to imaging pediatric pancreatitis are discussed, including timing of imaging, role of secretin-enhanced MRCP, utility of urgent MRI, severity prediction, autoimmune pancreatitis, and best methods for serial imaging. We suggest a methodical approach to pancreatic MRI interpretation in children and have included a sample structured report, and we provide consensus statements according to our experience imaging children with pancreatitis.
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21
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Jang DK, Lee JK. Recent development of endoscopic ultrasonography-guided drainage of pancreatic fluid collections. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2020. [DOI: 10.18528/ijgii200038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Dong Kee Jang
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Jun Kyu Lee
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
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22
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Leonard-Murali S, Lezotte J, Kalu R, Blyden DJ, Patton JH, Johnson JL, Gupta AH. Necrotizing pancreatitis: A review for the acute care surgeon. Am J Surg 2020; 221:927-934. [PMID: 32878690 DOI: 10.1016/j.amjsurg.2020.08.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 07/30/2020] [Accepted: 08/22/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Necrotizing pancreatitis is a common condition with high mortality; the acute care surgeon is frequently consulted for management recommendations. Furthermore, there has been substantial change in the timing, approach, and frequency of surgical intervention for this group of patients. METHODS In this article we summarize key clinical and research developments regarding necrotizing pancreatitis, including current recommendations for treatment of patients requiring intensive care and those with common complications. Articles from all years were considered to provide proper historical context, and most recent management recommendations are identified. RESULTS Epidemiology, diagnosis, treatment in the acute phase, and complications (both short-term and long-term) are discussed. Images of surgical interventions are included from our institutional experience. CONCLUSION Necrotizing pancreatitis management remains heavily based on clinical judgement, although technological advances and clinical trials have made decision making more straightforward.
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Affiliation(s)
- Shravan Leonard-Murali
- Department of Surgery, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI, 48202, USA.
| | - Jonathan Lezotte
- Department of Surgery, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI, 48202, USA.
| | - Richard Kalu
- Department of Surgery, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI, 48202, USA.
| | - Dionne J Blyden
- Department of Surgery, Division of Acute Care Surgery, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI, 48202, USA.
| | - Joe H Patton
- Department of Surgery, Division of Acute Care Surgery, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI, 48202, USA.
| | - Jeffrey L Johnson
- Department of Surgery, Division of Acute Care Surgery, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI, 48202, USA.
| | - Arielle H Gupta
- Department of Surgery, Division of Acute Care Surgery, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI, 48202, USA.
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23
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Maldonado I, Shetty A, Estay MC, Siña E, Rojas A, Narra V, Varela C. Acute Pancreatitis Imaging in MDCT: State of the Art of Usual and Unusual Local Complications. 2012 Atlanta Classification Revisited. Curr Probl Diagn Radiol 2020; 50:186-199. [PMID: 32553440 DOI: 10.1067/j.cpradiol.2020.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 11/15/2019] [Accepted: 04/06/2020] [Indexed: 01/31/2023]
Abstract
Acute pancreatitis is an inflammatory disease in which most common etiologies are biliary lithiasis and alcoholism. Acute pancreatitis can be classified into 2 groups according to its morphologic features: interstitial edematous pancreatitis and necrotizing acute pancreatitis. The prognosis of this group of diseases and its complications varies significantly and contrast-enhanced computed tomography is the imaging study of choice for the diagnosis and detection of complications. . In this review, we aim to summarize the changes introduced in the revised Atlanta classification and describe other usual and unusual local complications of acute pancreatitis that are not analyzed in that classification. We will also describe early detection signs and provide an accurate interpretation of complications on contrast-enhanced computed tomography that will lead to prompt management decisions which can reduce the morbidity and mortality of these patients.
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Affiliation(s)
- Ignacio Maldonado
- Departamento Imagenología, Clínica Dávila, Facultad de Medicina Universidad de los Andes y Universidad Mayor, Santiago, Chile.
| | - Anup Shetty
- Mallinckdrodt Institute of Radiology (MIR), Washington University in St. Louis, School of Medicine, St. Louis, MO
| | - María Catalina Estay
- Departamento Imagenología, Clínica Dávila, Facultad de Medicina Universidad de los Andes y Universidad Mayor, Santiago, Chile
| | - Eduardo Siña
- Universidad de los Andes, Facultad de Medicina, Santiago, Chile
| | - Alberto Rojas
- Universidad de los Andes, Facultad de Medicina, Santiago, Chile
| | - Vampsi Narra
- Mallinckdrodt Institute of Radiology (MIR), Washington University in St. Louis, School of Medicine, St. Louis, MO
| | - Cristian Varela
- Departamento Imagenología, Clínica Dávila, Facultad de Medicina Universidad de los Andes y Universidad Mayor, Santiago, Chile
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24
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Gurakar M, Faghih M, Singh VK. Endoscopic intervention in pancreatitis: perspectives from a gastroenterologist. Abdom Radiol (NY) 2020; 45:1308-1315. [PMID: 31768596 DOI: 10.1007/s00261-019-02314-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The last decade has seen a dramatic paradigm shift for the treatment of pancreatitis and its related complications away from surgery to minimally invasive endoscopic approaches. In this review, we provide an overview of the indications, techniques and outcomes of endoscopic interventions in the management of acute and chronic pancreatitis. Emphasis is placed on drainage of pancreatic pseudocysts and treatment of pain in chronic pancreatitis.
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Affiliation(s)
- Merve Gurakar
- Division of Gastroenterology, Pancreatitis Center, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Mahya Faghih
- Division of Gastroenterology, Pancreatitis Center, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Vikesh K Singh
- Division of Gastroenterology, Pancreatitis Center, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
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25
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Abstract
Pancreatic fluid collections (PFC), including pancreatic pseudocysts and walled-off pancreatic necrosis, are a known complication of severe acute pancreatitis. A majority of the PFCs remain asymptomatic and resolve spontaneously. However, some PFCs persist and can become symptomatic. Persistent PFCs can also cause further complications such as the gastric outlet, intestinal, or biliary obstruction and infection. Surgical interventions are indicated for the drainage of symptomatic sterile and infected PFCs. Management of PFCs has evolved from a primarily surgical or percutaneous approach to a less invasive endoscopic approach. Endoscopic interventions are associated with improved outcomes with lesser chances of complications, faster recovery time, and lower healthcare utilization. Endoscopic ultrasound-guided drainage of PFCs using lumen-apposing metal stents has become the preferred approach for the management of symptomatic and complicated PFCs.
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26
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Wu HC, Wang HP, Chen CC, Wu CH, Liu TH, Wang CH, Shih LN, Liao WC. Urinary trypsinogen-2 level and local complications of acute pancreatitis. J Gastroenterol Hepatol 2019; 34:2043-2049. [PMID: 31039289 DOI: 10.1111/jgh.14698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 04/18/2019] [Accepted: 04/25/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIM Local complications of acute pancreatitis (AP) carry risks of morbidity/mortality. This study aimed to assess whether urinary trypsinogen-2 levels and Bedside Index for Severity in Acute Pancreatitis (BISAP) score on admission predicted subsequent local complications. METHODS One hundred and forty-four consecutive patients with AP were prospectively followed till 6 months after discharge. Urinary trypsinogen-2 levels were measured within 24 h of admission. Local complications (acute peripancreatic fluid collection, acute necrotic collection, pseudocyst, and walled-off necrosis) were diagnosed by abdominal computed tomography. Cut-off for trypsinogen-2 level was assessed using receiver operating characteristic curve, and predictors of local complications were analyzed by logistic regression. RESULTS Thirty-seven (25.7%) patients developed local complications. Urinary trypsinogen-2 levels were significantly higher in patients with local complications compared with those without local complications (median [interquartile range], 3210 [620-9764.4] μg/L vs 627.3 [72.3-5895] μg/L, P = 0.006). Urinary trypsinogen-2 significantly outperformed BISAP score in predicting local complications (area under the receiver operating characteristic curve 0.65 [95% CI: 0.55-0.75] vs 0.48 [95% CI: 0.38-0.58], P = 0.005). At the optimal cut-off of 500 μg/L, the sensitivity, specificity, positive predictive value, and negative predictive value of trypsinogen-2 level were 78.4%, 45.8%, 33.3%, and 86.0%, respectively. Urinary trypsinogen-2 level > 500 μg/L was an independent predictor of local complications (adjusted odds ratio, 3.72; 95% CI: 1.42-9.76; P = 0.007). By contrast, BISAP score ≥ 3 and pleural effusion predicted organ failure but not local complications. CONCLUSION In a prospective cohort, urinary trypsinogen-2 level > 500 μg/L independently predicted local complications of AP.
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Affiliation(s)
- Hsing-Chien Wu
- Taipei Hospital, Ministry of Health and Welfare, Taipei, Taiwan
| | - Hsiu-Po Wang
- Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chieh-Chang Chen
- Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chien-Hsien Wu
- Taipei Hospital, Ministry of Health and Welfare, Taipei, Taiwan
| | - Ting-Hsu Liu
- Taipei Hospital, Ministry of Health and Welfare, Taipei, Taiwan
| | - Chih-Hsien Wang
- Taipei Hospital, Ministry of Health and Welfare, Taipei, Taiwan
| | - Ling-Na Shih
- Lo-Sheng Sanatorium and Hospital, Ministry of Health and Welfare, Taipei, Taiwan
| | - Wei-Chih Liao
- Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
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27
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Can Disturbed Liver Perfusion Revealed in p-CT on the First Day of Acute Pancreatitis Provide Information about the Expected Severity of the Disease? Gastroenterol Res Pract 2019; 2019:6590729. [PMID: 31485219 PMCID: PMC6710743 DOI: 10.1155/2019/6590729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 04/24/2019] [Accepted: 07/26/2019] [Indexed: 02/06/2023] Open
Abstract
Background The aim of the study was to evaluate the prognostic properties of perfusion parameters of liver parenchyma based on computed tomography (CT) of patients with acute pancreatitis (AP) made on the first day of onset of symptoms, to assess their usefulness in identifying patients with increased risk of the development of severe AP. Methods 79 patients with clinical symptoms and biochemical criteria indicative of AP underwent perfusion computed tomography (p-CT) within 24 hours after onset of the symptoms. Perfusion parameters in 41 people who developed a severe form of AP were compared with parameters in 38 patients in whom the course of AP was mild. Results Statistical differences in the liver perfusion parameters between the group of patients with mild and severe AP were shown. The permeability-surface area product was significantly lower, and the hepatic arterial fraction was significantly higher in the group of patients with progression of AP. Conclusions Based on the results, it seems that p-CT performed on the first day from the onset of AP is a method that, by revealing disturbances in hepatic perfusion, can help in identifying patients with increased risk of the development of severe AP.
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28
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Bansal A, Gupta P, Singh H, Samanta J, Mandavdhare H, Sharma V, Sinha SK, Dutta U, Kochhar R. Gastrointestinal complications in acute and chronic pancreatitis. JGH OPEN 2019; 3:450-455. [PMID: 31832543 PMCID: PMC6891019 DOI: 10.1002/jgh3.12185] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 02/06/2019] [Accepted: 03/21/2019] [Indexed: 01/09/2023]
Abstract
Pancreatitis is one of the important medical conditions. Gastrointestinal (GI) complications of pancreatitis are important and lead to significant morbidity and mortality. Diagnosis of these complications is difficult and may require a strong clinical suspicion coupled with various imaging features. This review provides an extensive update of the whole spectrum of GI complication of pancreatitis, both acute and chronic, from inflammation, ischemia, and necrosis to obstruction, perforation, and GI fistulae. The focus is on the clinical and imaging features of this less commonly described aspect of pancreatitis.
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Affiliation(s)
- Akash Bansal
- Department of Radiodiagnosis Postgraduate Institute of Medical Education and Research (PGIMER) Chandigarh India
| | - Pankaj Gupta
- Department of Gastroenterology Postgraduate Institute of Medical Education and Research (PGIMER) Chandigarh India
| | - Harjeet Singh
- Department of Surgery Postgraduate Institute of Medical Education and Research (PGIMER) Chandigarh India
| | - Jayanta Samanta
- Department of Gastroenterology Postgraduate Institute of Medical Education and Research (PGIMER) Chandigarh India
| | - Harshal Mandavdhare
- Department of Gastroenterology Postgraduate Institute of Medical Education and Research (PGIMER) Chandigarh India
| | - Vishal Sharma
- Department of Gastroenterology Postgraduate Institute of Medical Education and Research (PGIMER) Chandigarh India
| | - Saroj K Sinha
- Department of Gastroenterology Postgraduate Institute of Medical Education and Research (PGIMER) Chandigarh India
| | - Usha Dutta
- Department of Gastroenterology Postgraduate Institute of Medical Education and Research (PGIMER) Chandigarh India
| | - Rakesh Kochhar
- Department of Gastroenterology Postgraduate Institute of Medical Education and Research (PGIMER) Chandigarh India
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29
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Bezmarević M, van Dijk SM, Voermans RP, van Santvoort HC, Besselink MG. Management of (Peri)Pancreatic Collections in Acute Pancreatitis. Visc Med 2019; 35:91-96. [PMID: 31192242 DOI: 10.1159/000499631] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 03/15/2019] [Indexed: 12/12/2022] Open
Abstract
The development of (peri)pancreatic fluid collections are frequent local complications in acute pancreatitis. These collections are classified as early (acute peripancreatic fluid collection or acute necrotic collection) or late (walled-off necrosis or pseudocyst). The majority of pancreatic fluid collections resolve spontaneously and do not require intervention. However, infection may require intervention. Interventions may include endoscopic or percutaneous catheter drainage, or in a next step endoscopic or surgical necrosectomy, minimally invasive or open. The best timing for the first intervention is still under investigation. Whereas some use antibiotics to postpone intervention until the stage of walled-off necrosis, others drain earlier. Endoscopic drainage of (peri)pancreatic fluid collections is now the preferred approach of drainage due to reduced morbidity as compared to surgical or percutaneous drainage. However, each collection must be treated according to a tailored approach. The final treatment should take into consideration anatomic characteristics, patient preference, comorbidity profile of the patient, and physician discretion. This review summarizes the current evidence on the treatment of (peri)pancreatic fluid collections.
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Affiliation(s)
- Mihailo Bezmarević
- Department of Hepatobiliary and Pancreatic Surgery, Clinic for General Surgery, Military Medical Academy, University of Defense, Belgrade, Serbia.,Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Sven M van Dijk
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Research and Development, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Rogier P Voermans
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Hjalmar C van Santvoort
- Department of Surgery, St. Antonius Hospital, Utrecht, The Netherlands.,Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marc G Besselink
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Grassedonio E, Toia P, La Grutta L, Palmucci S, Smeraldi T, Cutaia G, Albano D, Midiri F, Galia M, Midiri M. Role of computed tomography and magnetic resonance imaging in local complications of acute pancreatitis. Gland Surg 2019; 8:123-132. [PMID: 31183322 DOI: 10.21037/gs.2018.12.07] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Acute pancreatitis (AP) represents a pancreas inflammation of sudden onset that can present different degrees of severity. AP is a frequent cause of acute abdomen and its complications are still a cause of death. Biliary calculosis and alcohol abuse are the most frequent cause of AP. Computed tomography (CT) and magnetic resonance imaging (MRI) are not necessary for the diagnosis of AP but they are fundamental tools for the identification of the cause, degree severity and AP complications. AP severity assessment is in fact one of the most important issue in disease management. Contrast-enhanced CT is preferred in the emergency setting and is considered the gold standard in patients with AP. MRI is comparable to CT for the diagnosis of AP but requires much more time so it is not usually chosen in the emergency scenario. Complications of AP can be distinguished in localized and generalized. Among the localized complications, we can identify: acute peripancreatic fluid collections (APFC), pseudocysts, acute necrotic collections (ANC), walled off pancreatic necrosis (WOPN), venous thrombosis, pseudoaneurysms and haemorrhage. Multiple organ failure syndrome (MOFS) and sepsis are possible generalized complications of AP. In this review, we focus on CT and MRI findings in local complications of AP and when and how to perform CT and MRI. We paid also attention to recent developments in diagnostic classification of AP complications.
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Affiliation(s)
| | - Patrizia Toia
- Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
| | | | - Stefano Palmucci
- Department of Medical Surgical Sciences and Advanced Technologies, Radiology I Unit, University Hospital "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Tommaso Smeraldi
- Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
| | - Giuseppe Cutaia
- Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
| | - Domenico Albano
- Unit of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Federico Midiri
- Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
| | - Massimo Galia
- Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
| | - Massimo Midiri
- Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
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Farias GF, Bernardo WM, De Moura DT, Guedes HG, Brunaldi VO, Visconti TADC, Gonçalves CV, Sakai CM, Matuguma SE, dos Santos ME, Sakai P, De Moura EG. Endoscopic versus surgical treatment for pancreatic pseudocysts: Systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e14255. [PMID: 30813129 PMCID: PMC6407966 DOI: 10.1097/md.0000000000014255] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE This systematic review and meta-analysis aims to compare surgical and endoscopic treatment for pancreatic pseudocyst (PP). METHODS The researchers did a search in Medline, EMBASE, Scielo/Lilacs, and Cochrane electronic databases for studies comparing surgical and endoscopic drainage of PP s in adult patients. Then, the extracted data were used to perform a meta-analysis. The outcomes were therapeutic success, drainage-related adverse events, general adverse events, recurrence rate, cost, and time of hospitalization. RESULTS There was no significant difference between treatment success rate (risk difference [RD] -0.09; 95% confidence interval [CI] [0.20,0.01]; P = .07), drainage-related adverse events (RD -0.02; 95% CI [-0.04,0.08]; P = .48), general adverse events (RD -0.05; 95% CI [-0.12, 0.02]; P = .13) and recurrence (RD: 0.02; 95% CI [-0.04,0.07]; P = .58) between surgical and endoscopic treatment.Regarding time of hospitalization, the endoscopic group had better results (RD: -4.23; 95% CI [-5.18, -3.29]; P < .00001). When it comes to treatment cost, the endoscopic arm also had better outcomes (RD: -4.68; 95% CI [-5.43,-3.94]; P < .00001). CONCLUSION There is no significant difference between surgical and endoscopic treatment success rates, adverse events and recurrence for PP. However, time of hospitalization and treatment costs were lower in the endoscopic group.
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Affiliation(s)
- Galileu F.A. Farias
- Gastroenterology Department, Gastrointestinal Endoscopy Unit, University of Sao Paulo School of Medicine, Avenida Dr. Enéas de Carvalho Aguiar
| | - Wanderley M. Bernardo
- Thoracic Surgery Department, Instituto do Coração (InCor, Heart Institute), University of Sao Paulo School of Medicine, São Paulo, Brazil
| | - Diogo T.H. De Moura
- Gastroenterology Department, Gastrointestinal Endoscopy Unit, University of Sao Paulo School of Medicine, Avenida Dr. Enéas de Carvalho Aguiar
| | | | - Vitor O. Brunaldi
- Gastroenterology Department, Gastrointestinal Endoscopy Unit, University of Sao Paulo School of Medicine, Avenida Dr. Enéas de Carvalho Aguiar
| | - Thiago A. de C. Visconti
- Gastroenterology Department, Gastrointestinal Endoscopy Unit, University of Sao Paulo School of Medicine, Avenida Dr. Enéas de Carvalho Aguiar
| | - Caio V.T. Gonçalves
- Gastroenterology Department, Gastrointestinal Endoscopy Unit, University of Sao Paulo School of Medicine, Avenida Dr. Enéas de Carvalho Aguiar
| | - Christiano M. Sakai
- Gastroenterology Department, Gastrointestinal Endoscopy Unit, University of Sao Paulo School of Medicine, Avenida Dr. Enéas de Carvalho Aguiar
| | - Sergio E. Matuguma
- Gastroenterology Department, Gastrointestinal Endoscopy Unit, University of Sao Paulo School of Medicine, Avenida Dr. Enéas de Carvalho Aguiar
| | - Marcos E.L. dos Santos
- Gastroenterology Department, Gastrointestinal Endoscopy Unit, University of Sao Paulo School of Medicine, Avenida Dr. Enéas de Carvalho Aguiar
| | - Paulo Sakai
- Gastroenterology Department, Gastrointestinal Endoscopy Unit, University of Sao Paulo School of Medicine, Avenida Dr. Enéas de Carvalho Aguiar
| | - Eduardo G.H. De Moura
- Gastroenterology Department, Gastrointestinal Endoscopy Unit, University of Sao Paulo School of Medicine, Avenida Dr. Enéas de Carvalho Aguiar
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Obaitan I, Hayat U, Hashmi H, Trikudanathan G. Imaging in pancreatitis: current status and recent advances. Expert Opin Orphan Drugs 2018. [DOI: 10.1080/21678707.2018.1536539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Itegbemie Obaitan
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Umar Hayat
- Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, MN, USA
| | - Hiba Hashmi
- Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, MN, USA
| | - Guru Trikudanathan
- Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, MN, USA
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Brimhall B, Han S, Tatman PD, Clark TJ, Wani S, Brauer B, Edmundowicz S, Wagh MS, Attwell A, Hammad H, Shah RJ. Increased Incidence of Pseudoaneurysm Bleeding With Lumen-Apposing Metal Stents Compared to Double-Pigtail Plastic Stents in Patients With Peripancreatic Fluid Collections. Clin Gastroenterol Hepatol 2018; 16:1521-1528. [PMID: 29474970 PMCID: PMC6429551 DOI: 10.1016/j.cgh.2018.02.021] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 01/26/2018] [Accepted: 02/02/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS There have been few studies that compared the effects of lumen-apposing metal stents (LAMS) and double-pigtail plastic stents (DPS) in patients with peripancreatic fluid collections from pancreatitis. We aimed to compare technical and clinical success and adverse events in patients who received LAMS vs DPS for pancreatic pseudocysts and walled-off necrosis. METHODS We performed a retrospective study of endoscopic ultrasound-mediated drainage in 149 patients (65% male; mean age, 47 y) with pancreatic pseudocysts or walled-off necrosis (97 received LAMS and 152 received DPS), from January 2011 through September 2016 at a single center. We collected data on patient characteristics, outcomes, hospitalizations, and imaging findings. Technical success was defined as LAMS insertion or a minimum of 2 DPS. Clinical success was defined as resolution of pancreatic pseudocysts or walled-off necrosis based on imaging results. The primary outcome was resolution of peripancreatic fluid collection with reduced abdominal pain or obstructive signs or symptoms. Secondary outcomes included the identification and management of adverse events, number of additional procedures required to resolve fluid collection, and the recurrence of fluid collection. RESULTS Patients who received LAMS had larger peripancreatic fluid collections than patients who received DPS prior to intervention (P = .001), and underwent an average 1.7 interventions vs 1.9 interventions for patients who received DPS (P = .93). Technical success was achieved for 90 patients with LAMS (92.8%) vs 137 patients with DPS (90.1%) (odds ratio [OR] for success with DPS, 0.82; 95% CI, 0.33-2.0; P = .67). Despite larger fluid collections in the LAMS group, there was no significant difference in proportions of patients with clinical success following placement of LAMS (82 of 84 patients, 97.6%) vs DPS (118 of 122 patients, 96.7%) (OR for clinical success with DPS, 0.73; 95% CI, 0.13-4.0; P = .71). Adverse events developed in 24 patients who received LAMS (24.7%) vs 27 patients who received DPS (17.8%) (OR for an adverse event in a patient receiving a DPS, 0.82; 95% CI, 0.33-2.0; P = .67). However, patients with LAMS had a higher risk of pseudoaneurysm bleeding than patients with DPS (OR, 10.0; 95% CI, 1.19-84.6; P = .009). CONCLUSIONS In a retrospective study of patients undergoing drainage of pancreatic pseudocysts or walled-off necrosis, we found LAMS and DPS to have comparable rates of technical and clinical success and adverse events. Drainage of walled-off necrosis or pancreatic pseudocysts using DPS was associated with fewer bleeding events overall, including pseudoaneurysm bleeding, but bleeding risk with LAMS should be weighed against the trend of higher actionable perforation and infection rates with DPS.
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Affiliation(s)
- Bryan Brimhall
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Samuel Han
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Philip D Tatman
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Toshimasa J Clark
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Sachin Wani
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Brian Brauer
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Steven Edmundowicz
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Mihir S Wagh
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Augustin Attwell
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Hazem Hammad
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Raj J Shah
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
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Elta GH, Enestvedt BK, Sauer BG, Lennon AM. ACG Clinical Guideline: Diagnosis and Management of Pancreatic Cysts. Am J Gastroenterol 2018; 113:464-479. [PMID: 29485131 DOI: 10.1038/ajg.2018.14] [Citation(s) in RCA: 396] [Impact Index Per Article: 56.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 01/05/2018] [Indexed: 02/07/2023]
Abstract
Pancreatic cysts are very common with the majority incidentally identified. There are several types of pancreatic cysts; some types can contain cancer or have malignant potential, whereas others are benign. However, even the types of cysts with malignant potential rarely progress to cancer. At the present time, the only viable treatment for pancreatic cysts is surgical excision, which is associated with a high morbidity and occasional mortality. The small risk of malignant transformation, the high risks of surgical treatment, and the lack of high-quality prospective studies have led to contradictory recommendations for their immediate management and for their surveillance. This guideline will provide a practical approach to pancreatic cyst management and recommendations for cyst surveillance for the general gastroenterologist.
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Affiliation(s)
- Grace H Elta
- Division of Gastroenterology, University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | - Brintha K Enestvedt
- Division of Gastroenterology, Oregon Health and Sciences University, Portland, Oregon, USA
| | - Bryan G Sauer
- Division of Gastroenterology, University of Virginia, Charlottesville, Virginia, USA
| | - Anne Marie Lennon
- Division of Gastroenterology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
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Manrai M, Kochhar R, Gupta V, Yadav TD, Dhaka N, Kalra N, Sinha SK, Khandelwal N. Outcome of Acute Pancreatic and Peripancreatic Collections Occurring in Patients With Acute Pancreatitis. Ann Surg 2018; 267:357-363. [PMID: 27805963 DOI: 10.1097/sla.0000000000002065] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To study the outcome of acute collections occurring in patients with acute pancreatitis BACKGROUND:: There are limited data on natural history of acute collections arising after acute pancreatitis (AP). METHODS Consecutive patients of AP admitted between July 2011 and December 2012 were evaluated by imaging for development of acute collections as defined by revised Atlanta classification. Imaging was repeated at 1 and 3 months. Spontaneous resolution, evolution, and need for intervention were assessed. RESULTS Of the 189 patients, 151 patients (79.9%) had acute collections with severe disease and delayed hospitalization being predictors of acute collections. Thirty-six patients had acute interstitial edematous pancreatitis, 8 of whom developed acute peripancreatic fluid collections, of which 1 evolved into pseudocyst. Among the 153 patients with acute necrotizing pancreatitis, 143 (93.4%) developed acute necrotic collection (ANC). Twenty-three of 143 ANC patients died, 21 had resolved collections, whereas 84 developed walled-off necrosis (WON), with necrosis >30% (P = 0.010) and Computed Tomographic Severity Index score ≥7 (P = 0.048) predicting development of WON. Of the 84 patients with WON, 8 expired, 53 patients required an intervention, and 23 were managed conservatively. Independent predictors of any intervention among all patients were Computed Tomographic Severity Index score ≥7 (P < 0.001) and interval between onset of pain to hospitalization >7 days (P = 0.04). CONCLUSIONS Patients with severe AP and delayed hospitalization more often develop acute collections. Pancreatic pseudocysts are a rarity in acute interstitial pancreatitis. A majority of patients with necrotising pancreatitis will develop ANC, more than half of whom will develop WON. Delay in hospitalization and higher baseline necrosis score predict need for intervention.
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Affiliation(s)
- Manish Manrai
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh Kochhar
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikas Gupta
- Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Thakur Deen Yadav
- Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Narendra Dhaka
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Naveen Kalra
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Saroj K Sinha
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Niranjan Khandelwal
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Sentetik Kannabinoid İntoksikasyonunun Abdominal Bilgisayarlı Tomografi Bulguları: Vaka Sunumu. JOURNAL OF CONTEMPORARY MEDICINE 2017. [DOI: 10.16899/gopctd.359976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Foster BR, Jensen KK, Bakis G, Shaaban AM, Coakley FV. Revised Atlanta Classification for Acute Pancreatitis: A Pictorial Essay. Radiographics 2017; 36:675-87. [PMID: 27163588 DOI: 10.1148/rg.2016150097] [Citation(s) in RCA: 116] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The 2012 revised Atlanta classification is an update of the original 1992 Atlanta classification, a standardized clinical and radiologic nomenclature for acute pancreatitis and associated complications based on research advances made over the past 2 decades. Acute pancreatitis is now divided into two distinct subtypes, necrotizing pancreatitis and interstitial edematous pancreatitis (IEP), based on the presence or absence of necrosis, respectively. The revised classification system also updates confusing and sometimes inaccurate terminology that was previously used to describe pancreatic and peripancreatic collections. As such, use of the terms acute pseudocyst and pancreatic abscess is now discouraged. Instead, four distinct collection subtypes are identified on the basis of the presence of pancreatic necrosis and time elapsed since the onset of pancreatitis. Acute peripancreatic fluid collections (APFCs) and pseudocysts occur in IEP and contain fluid only. Acute necrotic collections (ANCs) and walled-off necrosis (WON) occur only in patients with necrotizing pancreatitis and contain variable amounts of fluid and necrotic debris. APFCs and ANCs occur within 4 weeks of disease onset. After this time, APFCs or ANCs may either resolve or persist, developing a mature wall to become a pseudocyst or a WON, respectively. Any collection subtype may become infected and manifest as internal gas, though this occurs most commonly in necrotic collections. In this review, the authors present a practical image-rich guide to the revised Atlanta classification system, with the goal of fostering implementation of the revised system into radiology practice, thereby facilitating accurate communication among clinicians and reinforcing the radiologist's role as a key member of a multidisciplinary team in treating patients with acute pancreatitis. (©)RSNA, 2016.
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Affiliation(s)
- Bryan R Foster
- From the Department of Diagnostic Radiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239 (B.R.F., K.K.J., G.B., F.V.C.); and Department of Radiology, University of Utah, Salt Lake City, Utah (A.M.S.)
| | - Kyle K Jensen
- From the Department of Diagnostic Radiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239 (B.R.F., K.K.J., G.B., F.V.C.); and Department of Radiology, University of Utah, Salt Lake City, Utah (A.M.S.)
| | - Gene Bakis
- From the Department of Diagnostic Radiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239 (B.R.F., K.K.J., G.B., F.V.C.); and Department of Radiology, University of Utah, Salt Lake City, Utah (A.M.S.)
| | - Akram M Shaaban
- From the Department of Diagnostic Radiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239 (B.R.F., K.K.J., G.B., F.V.C.); and Department of Radiology, University of Utah, Salt Lake City, Utah (A.M.S.)
| | - Fergus V Coakley
- From the Department of Diagnostic Radiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239 (B.R.F., K.K.J., G.B., F.V.C.); and Department of Radiology, University of Utah, Salt Lake City, Utah (A.M.S.)
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Souza GDD, Souza LRQ, Cuenca RM, Jerônimo BSDM, Souza GMD, Vilela VM. UNDERSTANDING THE INTERNATIONAL CONSENSUS FOR ACUTE PANCREATITIS: CLASSIFICATION OF ATLANTA 2012. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2017; 29:206-210. [PMID: 27759788 PMCID: PMC5074676 DOI: 10.1590/0102-6720201600030018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 03/23/2016] [Indexed: 12/15/2022]
Abstract
Introduction: Contrast computed tomography and magnetic resonance imaging are widely used due to its image quality and ability to study pancreatic and peripancreatic morphology. The understanding of the various subtypes of the disease and identification of possible complications requires a familiarity with the terminology, which allows effective communication between the different members of the multidisciplinary team. Aim: Demonstrate the terminology and parameters to identify the different classifications and findings of the disease based on the international consensus for acute pancreatitis ( Atlanta Classification 2012). Methods: Search and analysis of articles in the "CAPES Portal de Periódicos with headings "acute pancreatitis" and "Atlanta Review". Results: Were selected 23 articles containing radiological descriptions, management or statistical data related to pathology. Additional statistical data were obtained from Datasus and Population Census 2010. The radiological diagnostic criterion adopted was the Radiology American College system. The "acute pancreatitis - 2012 Rating: Review Atlanta classification and definitions for international consensus" tries to eliminate inconsistency and divergence from the determination of uniformity to the radiological findings, especially the terminology related to fluid collections. More broadly as "pancreatic abscess" and "phlegmon" went into disuse and the evolution of the collection of patient fluids can be described as "acute peripancreatic collections", "acute necrotic collections", "pseudocyst" and "necrosis pancreatic walled or isolated". Conclusion: Computed tomography and magnetic resonance represent the best techniques with sequential images available for diagnosis. Standardization of the terminology is critical and should improve the management of patients with multiple professionals care, risk stratification and adequate treatment.
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Affiliation(s)
- Gleim Dias de Souza
- Base Hospital of Federal District, Brasília, DF, Brazil.,Catholic University of Brasília, Brasília, DF, Brazil
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Current status of multi-detector row helical CT in imaging of adult acquired pancreatic diseases and assessing surgical neoplastic resectability. ALEXANDRIA JOURNAL OF MEDICINE 2017. [DOI: 10.1016/j.ajme.2016.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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40
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Hua Z, Su Y, Huang X, Zhang K, Yin Z, Wang X, Liu P. Analysis of risk factors related to gastrointestinal fistula in patients with severe acute pancreatitis: a retrospective study of 344 cases in a single Chinese center. BMC Gastroenterol 2017; 17:29. [PMID: 28193160 PMCID: PMC5307753 DOI: 10.1186/s12876-017-0587-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 02/09/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Gastrointestinal fistula (GIF) in severe acute pancreatitis (SAP) is considered as a sparse episode and studied sporadically in the literature. There is paucity of data on the prediction of the effect on risk of GIF in patient with SAP. This study was aimed to investigate risk factors related to GIF in the development of SAP. METHODS The clinical data of 344 patients with SAP from 2011 to 2016 were reviewed retrospectively. All patients were divided into the GIF group and the non-GIF group, and their data analyzed with respect to 15 parameters were applied to explore potential risk factors for GIF in patients with SAP. RESULTS Of the 344 eligible patients, 52 (15.12%) progressed to GIF. Only occurrence of infected pancreatic and extra-pancreatic necrosis (IPN) (P = 0.004, OR = 3.012) and modified CT severity index (MCTSI) (P = 0.033, OR = 1.183) were proved to be independent risk factors for GIF in patients with SAP, and blood type B (P = 0.048, OR = 2.096, 95% CI: 0.748-3.562) indicated weaker association of risk factor for GIF. The early (48-72 h after admission) enteral nutrition (EEN) (P = 0.016, OR = 0.267) acted as a protective factor. CONCLUSIONS Occurrence of IPN and high MCTSI are independent risk factors for the development of GIF in patients with SAP, blood type B reveals a potential correlation with GIF in patients with SAP. EEN is helpful to prevent the progression of GIF secondary to SAP.
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Affiliation(s)
- Zhipeng Hua
- Department of Hepatobiliary Surgery, Zhongshan Hospital of Xiamen University, Hubing South Road, Xiamen, Fujian, China
| | - Yongjie Su
- Department of Hepatobiliary Surgery, Zhongshan Hospital of Xiamen University, Hubing South Road, Xiamen, Fujian, China
| | - Xuefeng Huang
- Department of Hepatobiliary Surgery, Zhongshan Hospital of Xiamen University, Hubing South Road, Xiamen, Fujian, China
| | - Kang Zhang
- Fujian Provincial Key Laboratory of Chronic Liver Disease and Hepatocellular Carcinoma (Xiamen University Affiliated ZhongShan Hospital), Xiamen, China
| | - Zhengyu Yin
- Department of Hepatobiliary Surgery, Zhongshan Hospital of Xiamen University, Hubing South Road, Xiamen, Fujian, China.,Fujian Provincial Key Laboratory of Chronic Liver Disease and Hepatocellular Carcinoma (Xiamen University Affiliated ZhongShan Hospital), Xiamen, China
| | - Xiaoming Wang
- Department of Hepatobiliary Surgery, Zhongshan Hospital of Xiamen University, Hubing South Road, Xiamen, Fujian, China.,Fujian Provincial Key Laboratory of Chronic Liver Disease and Hepatocellular Carcinoma (Xiamen University Affiliated ZhongShan Hospital), Xiamen, China
| | - Pingguo Liu
- Department of Hepatobiliary Surgery, Zhongshan Hospital of Xiamen University, Hubing South Road, Xiamen, Fujian, China. .,Fujian Provincial Key Laboratory of Chronic Liver Disease and Hepatocellular Carcinoma (Xiamen University Affiliated ZhongShan Hospital), Xiamen, China.
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A Report of 320 Cases of Childhood Pancreatitis: Increasing Incidence, Etiologic Categorization, Dynamics, Severity Assessment, and Outcome. Pancreas 2017; 46:110-115. [PMID: 27846143 DOI: 10.1097/mpa.0000000000000733] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Because there is paucity of data on natural history of pediatric pancreatitis, we studied prevalence, etiology, severity, and outcome of pancreatitis. METHODS Over 12 years consecutive children with pancreatitis were included. Pancreatitis was classified as acute (AP), acute recurrent (ARP), and chronic pancreatitis (CP) as per standard definitions. RESULTS The study group comprised of 320 children (age, 11.4 ± 3.5 years, 201 males); AP, 160 (50%); ARP, 67 (21%); and CP, 93 (29%). The number of cases increased progressively from 28 to 157 between first and last quarter, and there was a significant increase (r = 0.92, P < 0.001) in AP-related hospitalizations over the years. Half of AP were idiopathic, 69% had severe pancreatitis (6 died) and on follow-up (21.1 ± 20.9 months) 21.5% progressed to either ARP (n = 8) or CP (n = 24). Progression was significantly associated with idiopathic etiology. The majority of ARP (70%) and CP (88%) were idiopathic and on follow-up (23.2 ± 28.9 months) 22% of ARP developed CP. CONCLUSIONS There was 7-fold increase in number of hospitalization due to pancreatitis over the years. Progression of AP to ARP/CP was noted in 21.5% and ARP to CP in 22%. Thus, a subset of pancreatitis seems to be a continuum of acute to ARP and CP.
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Ahmed A, Gibreel W, Sarr MG. Recognition and Importance of New Definitions of Peripancreatic Fluid Collections in Managing Patients with Acute Pancreatitis. Dig Surg 2016; 33:259-66. [PMID: 27216496 DOI: 10.1159/000445005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Our understanding of the etiopathogenesis of acute pancreatitis has matured tremendously in the last 3 decades. Advanced cross-sectional imaging with 3-dimensional techniques along with use of intravenous contrast to image the presence or absence of organ tissue perfusion has allowed early recognition of necrotizing pancreatitis. With this knowledge, the old terms to describe what used to be called 'peri-pancreatic fluid collections' we now recognize are no longer accurate nor appropriate. The 2013 revised Atlanta Classification has introduced a new, accurate, objective classification of acute pancreatitis and terminology for the natural history of all forms of acute pancreatitis that is easy to use and will help in both the description of the disease and its appropriate treatment. This review will describe these pancreatic and peri-pancreatic collections with added insight into their natural history.
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Affiliation(s)
- Akram Ahmed
- Department of Surgery, Mayo Clinic, Rochester, Minn., USA
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43
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Muthusamy VR, Chandrasekhara V, Acosta RD, Bruining DH, Chathadi KV, Eloubeidi MA, Faulx AL, Fonkalsrud L, Gurudu SR, Khashab MA, Kothari S, Lightdale JR, Pasha SF, Saltzman JR, Shaukat A, Wang A, Yang J, Cash BD, DeWitt JM. The role of endoscopy in the diagnosis and treatment of inflammatory pancreatic fluid collections. Gastrointest Endosc 2016; 83:481-8. [PMID: 26796695 DOI: 10.1016/j.gie.2015.11.027] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 11/18/2015] [Indexed: 02/06/2023]
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Pieńkowska J, Gwoździewicz K, Skrobisz-Balandowska K, Marek I, Kostro J, Szurowska E, Studniarek M. Perfusion-CT--Can We Predict Acute Pancreatitis Outcome within the First 24 Hours from the Onset of Symptoms? PLoS One 2016; 11:e0146965. [PMID: 26784348 PMCID: PMC4718557 DOI: 10.1371/journal.pone.0146965] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Accepted: 12/23/2015] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Severe acute pancreatitis (AP) is still a significant clinical problem which is associated with a highly mortality. The aim of this study was the evaluation of prognostic value of CT regional perfusion measurement performed on the first day of onset of symptoms of AP, in assessing the risk of developing severe form of acute pancreatitis. MATERIAL AND METHODS 79 patients with clinical symptoms and biochemical criteria indicative of acute pancreatitis (acute upper abdominal pain, elevated levels of serum amylase and lipase) underwent perfusion CT within 24 hours after onset of symptoms. The follow-up examinations were performed after 4-6 days to detect progression of the disease. Perfusion parameters were compared in 41 people who developed severe form of AP (pancreatic and/or peripancreatic tissue necrosis) with parameters in 38 consecutive patients in whom course of AP was mild. Blood flow, blood volume, mean transit time and permeability surface area product were calculated in the three anatomic pancreatic subdivisions (head, body and tail). At the same time the patient's clinical status was assessed by APACHE II score and laboratory parameters such as CRP, serum lipase and amylase, AST, ALT, GGT, ALP and bilirubin were compared. RESULTS Statistical differences in the perfusion parameters between the group of patients with mild and severe AP were shown. Blood flow, blood volume and mean transit time were significantly lower and permeability surface area product was significantly higher in patients who develop severe acute pancreatitis and presence of pancreatic and/or peripancreatic necrosis due to pancreatic ischemia. There were no statistically significant differences between the two groups in terms of evaluated on admission severity of pancreatitis assessed using APACHE II score and laboratory tests. CONCLUSIONS CT perfusion is a very useful indicator for prediction and selection patients in early stages of acute pancreatitis who are at risk of developing pancreatic and/or peripancreatic necrosis already on the first day of the onset of symptoms and can be used for treatment planning and monitoring of therapy of acute pancreatitis. Early suspicion of possible pancreatic necrosis both on the basis of scores based on clinical status and laboratory tests have low predictive value.
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Affiliation(s)
- Joanna Pieńkowska
- II Department of Radiology–Faculty of Health Sciences, Medical University of Gdansk, Gdansk, Poland
| | - Katarzyna Gwoździewicz
- I Department of Radiology–Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
- * E-mail:
| | | | - Iwona Marek
- Department of Gastroenterology and Hepatology, Medical University of Gdansk, Gdansk, Poland
| | - Justyna Kostro
- Department of General Endocrine and Transplant Surgery, Medical University of Gdansk, Gdansk, Poland
| | - Edyta Szurowska
- II Department of Radiology–Faculty of Health Sciences, Medical University of Gdansk, Gdansk, Poland
| | - Michał Studniarek
- I Department of Radiology–Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
- Department of Diagnostic Imaging, Medical University of Warsaw, Warsaw, Poland
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45
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Dhaka N, Samanta J, Kochhar S, Kalra N, Appasani S, Manrai M, Kochhar R. Pancreatic fluid collections: What is the ideal imaging technique? World J Gastroenterol 2015; 21:13403-13410. [PMID: 26730150 PMCID: PMC4690168 DOI: 10.3748/wjg.v21.i48.13403] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 07/18/2015] [Accepted: 09/30/2015] [Indexed: 02/06/2023] Open
Abstract
Pancreatic fluid collections (PFCs) are seen in up to 50% of cases of acute pancreatitis. The Revised Atlanta classification categorized these collections on the basis of duration of disease and contents, whether liquid alone or a mixture of fluid and necrotic debris. Management of these different types of collections differs because of the variable quantity of debris; while patients with pseudocysts can be drained by straight-forward stent placement, walled-off necrosis requires multi-disciplinary approach. Differentiating these collections on the basis of clinical severity alone is not reliable, so imaging is primarily performed. Contrast-enhanced computed tomography is the commonly used modality for the diagnosis and assessment of proportion of solid contents in PFCs; however with certain limitations such as use of iodinated contrast material especially in renal failure patients and radiation exposure. Magnetic resonance imaging (MRI) performs better than computed tomography (CT) in characterization of pancreatic/peripancreatic fluid collections especially for quantification of solid debris and fat necrosis (seen as fat density globules), and is an alternative in those situations where CT is contraindicated. Also magnetic resonance cholangiopancreatography is highly sensitive for detecting pancreatic duct disruption and choledocholithiasis. Endoscopic ultrasound is an evolving technique with higher reproducibility for fluid-to-debris component estimation with the added advantage of being a single stage procedure for both diagnosis (solid debris delineation) and management (drainage of collection) in the same sitting. Recently role of diffusion weighted MRI and positron emission tomography/CT with 18F-FDG labeled autologous leukocytes is also emerging for detection of infection noninvasively. Comparative studies between these imaging modalities are still limited. However we look forward to a time when this gap in literature will be fulfilled.
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46
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Bollen TL. Acute pancreatitis: international classification and nomenclature. Clin Radiol 2015; 71:121-33. [PMID: 26602933 DOI: 10.1016/j.crad.2015.09.013] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 09/09/2015] [Accepted: 09/24/2015] [Indexed: 12/11/2022]
Abstract
The incidence of acute pancreatitis (AP) is increasing and it is associated with a major healthcare concern. New insights in the pathophysiology, better imaging techniques, and novel treatment options for complicated AP prompted the update of the 1992 Atlanta Classification. Updated nomenclature for pancreatic collections based on imaging criteria is proposed. Adoption of the newly Revised Classification of Acute Pancreatitis 2012 by radiologists should help standardise reports and facilitate accurate conveyance of relevant findings to referring physicians involved in the care of patients with AP. This review will clarify the nomenclature of pancreatic collections in the setting of AP.
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Affiliation(s)
- T L Bollen
- Department of Radiology, St Antonius Hospital, Nieuwegein, The Netherlands.
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47
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Nakanishi N, Shimono T, Yamamoto A, Miki Y. CT evaluation and clinical factors predicting delayed colonic perforation following acute pancreatitis. Jpn J Radiol 2015; 34:10-5. [PMID: 26507985 DOI: 10.1007/s11604-015-0491-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 10/13/2015] [Indexed: 01/21/2023]
Abstract
PURPOSE Delayed colonic perforation after acute pancreatitis (AP) is a potentially lethal complication. This study investigated the frequency and predictors of delayed colonic perforation (DCP) following AP by reviewing the earliest laboratory data and computed tomography (CT) examination findings after pancreatitis onset. MATERIALS AND METHODS This retrospective study examined 75 consecutive cases of AP treated between April 2009 and April 2014. Laboratory data after onset and imaging features from earliest CT examinations (Balthazar grade, CT Severity Index) were reviewed. To clarify relationships between these data and DCP, univariate analyses were undertaken between perforated and nonperforated groups. RESULTS Delayed colonic perforation occurred in four of the 75 patients (5.3 %). Median duration to perforation after onset was 13 days (range 6-47). All four patients with DCP showed grade E according to Balthazar grade (≥2 peripancreatic collections and/or gas bubbles in or adjacent to pancreas). Univariate analyses identified Balthazar grade E as a risk factor for DCP (p = 0.0087). CONCLUSION Delayed colonic perforation is not uncommon and can occur a week or more after AP. Balthazar grade E on earliest CT after onset represents a risk factor for DCP.
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Affiliation(s)
- Noah Nakanishi
- Department of Diagnostic and Interventional Radiology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan.
| | - Taro Shimono
- Department of Diagnostic and Interventional Radiology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan.
| | - Akira Yamamoto
- Department of Diagnostic and Interventional Radiology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan.
| | - Yukio Miki
- Department of Diagnostic and Interventional Radiology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan.
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Acute Pancreatitis: Revised Atlanta Classification and the Role of Cross-Sectional Imaging. AJR Am J Roentgenol 2015; 205:W32-41. [PMID: 26102416 DOI: 10.2214/ajr.14.14056] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The 2012 revision of the Atlanta Classification emphasizes accurate characterization of collections that complicate acute pancreatitis: acute peripancreatic fluid collections, pseudocysts, acute necrotic collections, and walled-off necroses. As a result, the role of imaging in the management of acute pancreatitis has substantially increased. CONCLUSION This article reviews the imaging findings associated with acute pancreatitis and its complications on cross-sectional imaging and discusses the role of imaging in light of this revision.
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Abstract
Acute pancreatitis is an acute inflammation of the pancreas. Several classification systems have been used in the past but were considered unsatisfactory. A revised Atlanta classification of acute pancreatitis was published that assessed the clinical course and severity of disease; divided acute pancreatitis into interstitial edematous pancreatitis and necrotizing pancreatitis; discerned an early phase (first week) from a late phase (after the first week); and focused on systemic inflammatory response syndrome and organ failure. This article focuses on the revised classification of acute pancreatitis, with emphasis on imaging features, particularly on newly-termed fluid collections and implications for the radiologist.
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Affiliation(s)
- Ruedi F Thoeni
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, Medical School, PO Box 2829, San Francisco, CA 94126-2829, USA.
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50
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Sureka B, Bansal K, Patidar Y, Arora A. Imaging lexicon for acute pancreatitis: 2012 Atlanta Classification revisited. Gastroenterol Rep (Oxf) 2015. [PMID: 26224684 PMCID: PMC4760067 DOI: 10.1093/gastro/gov036] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The original 1992 Atlanta Classification System for acute pancreatitis was revised in 2012 by the Atlanta Working Group, assisted by various national and international societies, through web-based consensus. This revised classification identifies two phases of acute pancreatitis: early and late. Acute pancreatitis can be either oedematous interstitial pancreatitis or necrotizing pancreatitis. Severity of the disease is categorized into three levels: mild, moderately severe and severe, depending upon organ failure and local/systemic complications. According to the type of pancreatitis, collections are further divided into acute peripancreatic fluid collection, pseudocyst, acute necrotic collection, and walled-off necrosis. Insight into the revised terminology is essential for accurate communication of imaging findings. In this review article, we will summarize the updated nomenclature and illustrate corresponding imaging findings using examples.
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Affiliation(s)
- Binit Sureka
- Department of Radiology/Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Kalpana Bansal
- Department of Radiology/Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Yashwant Patidar
- Department of Radiology/Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Ankur Arora
- Department of Radiology/Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, India
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