• Acute pancreatitis
• epidemiology
• predictor
• prevalence
• severity
• temporal trend

• Humans
• Male
• Female
• China/epidemiology
• Pancreatitis/epidemiology
• Pancreatitis/mortality
• Middle Aged
• Adult
• Length of Stay/statistics & numerical data
• Aged
• Prevalence
• Sex Factors
• Severity of Illness Index
• Hospitalization/statistics & numerical data
• Hypertriglyceridemia/epidemiology
• Hypertriglyceridemia/complications
• Acute Disease

• Acute pancreatitis
• Aetiology
• Correct diagnosis
• Therapy

• apoptosis
• mitophagy
• monocyte macrophage
• sestrin2
• severe acute pancreatitis

• Animals
• Mitophagy/drug effects
• Mice
• Apoptosis
• Protein Kinases/metabolism
• RAW 264.7 Cells
• Ubiquitin-Protein Ligases/metabolism
• Ubiquitin-Protein Ligases/genetics
• Pancreatitis/metabolism
• Pancreatitis/pathology
• Pancreatitis/chemically induced
• Signal Transduction
• Mice, Knockout
• Mitochondria/metabolism
• Mice, Inbred C57BL
• Lipopolysaccharides/pharmacology
• Nuclear Proteins/metabolism
• Male
• Macrophages/metabolism
• Sestrins

• Acute pancreatitis
• ERCP
• Intensive-care unit
• Pancreas
• Practical guide
• Procalcitonin
• Walled-off necrosis

• Humans
• Pancreatitis/therapy
• Pancreatitis/diagnosis
• Pancreatitis/physiopathology
• Acute Disease
• Fluid Therapy/methods

• acute pancreatitis
• antibiotics
• duration of treatment
• infected pancreatic necrosis
• microbiology
• prophylactic therapy

• Changes of psychological status
• Intensive care unit nursing
• Psychological intervention
• Severe acute pancreatitis
• Short Form Health Survey

• acute pancreatitis
• anticoagulant therapy
• interventional radiology
• risk factor
• vascular complications

• Humans
• Male
• Female
• Middle Aged
• Risk Factors
• Pancreatitis/etiology
• Pancreatitis/epidemiology
• Pancreatitis/complications
• Retrospective Studies
• Adult
• Case-Control Studies
• Prevalence
• Treatment Outcome
• Aged
• Acute Disease
• Anticoagulants/therapeutic use
• Anticoagulants/adverse effects
• Vascular Diseases/etiology
• Vascular Diseases/epidemiology

• 22ZDYF0621 Sichuan Science and Technology Program
• 82270649 National Natural Science Foundation of China

• Anticoagulation
• Deep vein thrombosis
• Mesenteric vein thrombosis
• Pancreatitis
• Pulmonary thromboembolism
• Splanchnic vein thrombosis

• Humans
• Venous Thrombosis/etiology
• Venous Thrombosis/diagnostic imaging
• Venous Thrombosis/diagnosis
• Venous Thrombosis/therapy
• Pancreatitis/complications
• Pancreatitis/therapy
• Acute Disease

• ACUTE PANCREATITIS
• INTERVENTIONAL RADIOLOGY
• PANCREATIC SURGERY
• PANCREATITIS
• THERAPEUTIC ENDOSCOPY

• Humans
• Pancreatitis, Acute Necrotizing/complications
• Pancreatitis, Acute Necrotizing/surgery
• Follow-Up Studies
• Quality of Life
• Prospective Studies
• Exocrine Pancreatic Insufficiency/etiology
• Pancreatitis, Chronic/complications
• Drainage/adverse effects
• Necrosis
• Treatment Outcome

• dysbiosis
• gut microbiota
• gut–pancreas axis
• microbiota-based treatment
• pancreatitis

• Acute pancreatitis
• Analgesia
• Encuesta nacional
• National survey
• Pancreatitis aguda

• Humans
• Pain Management
• Acetaminophen/therapeutic use
• Dipyrone/therapeutic use
• Morphine
• Acute Disease
• Pancreatitis/drug therapy
• Pain
• Analgesia
• Meperidine/therapeutic use
• Analgesics/therapeutic use

• Humans
• Pancreatitis/diagnosis
• Pancreatitis/therapy
• Pancreatitis/etiology
• Acute Disease
• Isotonic Solutions/adverse effects
• Fluid Therapy/adverse effects
• Ringer's Lactate

• acute pancreatitis
• antibiotics
• probiotics
• prophylaxis

• Acute pancreatitis
• Meta-analysis
• Pancreatic encephalopathy
• Severe acute pancreatitis

• Humans
• Pancreatitis/complications
• Pancreatitis/epidemiology
• Acute Disease
• Incidence
• Multiple Organ Failure
• Brain Diseases/etiology

• 2019YFC1315901 National Key Research and Development Program of China

This review summarized the current controversies in the management of acute pancreatitis (AP). The controversies in management range from issues involving fluid resuscitation, nutrition, the role of antibiotics and antifungals, which analgesic to use, role of anticoagulation and intervention for complications in AP. The interventions vary from percutaneous drainage, endoscopy or surgery. Active research and emerging data are helping to formulate better guidelines. The available evidence favors crystalloids, although the choice and type of fluid resuscitation is an area of dynamic research. The nutrition aspect does not have controversy as of now as early enteral feeding is preferred most often than not. The empirical use of antibiotics and antifungals are gray zones, and more data is needed for conclusive guidelines. The choice of analgesic is being studied, and the recommendations are still evolving. The position of using anticoagulation is still awaiting consensus. The role of intervention is well established, although the modality is constantly changing and favoring endoscopy or percutaneous drainage rather than surgery. It is evident that more multicenter randomized controlled trials are required for establishing the standard of care in these crucial management issues of AP to improve the morbidity and mortality worldwide.

• Acute pancreatitis
• Fluid resuscitation
• Antibiotics
• Analgesia
• Anti coagulation
• Intervention

• Acute pancreatitis
• Aggressive intravenous hydration
• Meta-analysis
• Mortality
• Systematic review

• abdominal compartment syndrome
• acute pancreatitis
• compartment syndrome
• intra-abdominal hypertension
• surgery

Patients with acute pancreatitis (AP) often require ICU admission, especially when signs of multiorgan failure are present, a condition that defines AP as severe. This disease is characterized by a massive pancreatic release of pro-inflammatory cytokines that causes a systemic inflammatory response syndrome and a profound intravascular fluid loss. This leads to a mixed hypovolemic and distributive shock and ultimately to multiorgan failure. Aggressive fluid resuscitation is traditionally considered the mainstay treatment of AP. In fact, all available guidelines underline the importance of fluid therapy, particularly in the first 24–48 h after disease onset. However, there is currently no consensus neither about the type, nor about the optimal fluid rate, total volume, or goal of fluid administration. In general, a starting fluid rate of 5–10 ml/kg/h of Ringer’s lactate solution for the first 24 h has been recommended. Fluid administration should be aggressive in the first hours, and continued only for the appropriate time frame, being usually discontinued, or significantly reduced after the first 24–48 h after admission. Close clinical and hemodynamic monitoring along with the definition of clear resuscitation goals are fundamental. Generally accepted targets are urinary output, reversal of tachycardia and hypotension, and improvement of laboratory markers. However, the usefulness of different endpoints to guide fluid therapy is highly debated. The importance of close monitoring of fluid infusion and balance is acknowledged by most available guidelines to avoid the deleterious effect of fluid overload. Fluid therapy should be carefully tailored in patients with severe AP, as for other conditions frequently managed in the ICU requiring large fluid amounts, such as septic shock and burn injury. A combination of both noninvasive clinical and invasive hemodynamic parameters, and laboratory markers should guide clinicians in the early phase of severe AP to meet organ perfusion requirements with the proper administration of fluids while avoiding fluid overload. In this narrative review the most recent evidence about fluid therapy in severe AP is discussed and an operative algorithm for fluid administration based on an individualized approach is proposed.

• Acute pancreatitis
• Critical illness
• Crystalloid solutions
• Fluid therapy
• Ringer’s lactate

To establish a rapid and concise prognosis scoring system for pancreatitis in the emergency department based on bedside arterial blood gas analysis (ABG).

A single-center, retrospective cohort study was used to establish the new scoring system, and a validation group was used to verify it. The primary endpoint was 60-day death, and secondary endpoints were 28-day death, admission to the intensive care unit (AICU), requirement for mechanical ventilation (MV) and persistent organ failure (POF). Receiver operating characteristic (ROC) curves was drawn to validate the predictive value of the new scoring system. The performance of the new scoring system was compared with that of conventional predictive scoring.

443 patients were in the derivation group and 217 patients in the validation group, of which 27 and 25 died during follow-up. A total of 443 patients in the derivation group, 27 of whom died during the follow-up period. Multivariate regression analysis showed that mental status, hematocrit (HCT), base excess (BE) and Serum ionic calcium (Ca²⁺) were independent risk factors for 60-day mortality of pancreatitis, and they were used to create a new scoring system (MHBC). In the derivation and validation, the ability of MHBC (AUC= 0.922, 0.773, respectively) to predict 60-day mortality from pancreatitis was no less than that of APACHE II (AUC= 0.838, 0.748, respectively) and BISAP (AUC= 0.791, 0.750, respectively), while, MHBC is more quickly and concisely than APACHE II and BISAP. Compared with MHBC less than or equal to 2, when MHBC is greater than 2, the 28-day mortality, 60-day mortality and the incidence of AICU, MV and POF increased significantly (P <0.001).

The MHBC can quickly and concisely evaluate the 60-day mortality, 28-day mortality, and the incidence of AICU, MV and POF of patients with acute pancreatitis in the emergency department.

• ABG
• acute pancreatitis
• arterial blood gas analysis
• emergency department
• prognosis

• Acute Disease
• Humans
• Pancreatitis, Acute Necrotizing/diagnosis
• Pancreatitis, Acute Necrotizing/therapy
• Risk Assessment

Background: Current approaches to predicting intervention needs and mortality have reached 65–85% accuracy, which falls below clinical decision-making requirements in patients with acute pancreatitis (AP). We aimed to accurately predict therapeutic intervention needs and mortality on admission, in AP patients, using machine learning (ML). Methods: Data were obtained from three databases of patients admitted with AP: one retrospective (Chengdu) and two prospective (Liverpool and Chengdu) databases. Intervention and mortality differences, as well as potential predictors, were investigated. Univariate analysis was conducted, followed by a random forest ML algorithm used in multivariate analysis, to identify predictors. The ML performance matrix was applied to evaluate the model’s performance. Results: Three datasets of 2846 patients included 25 potential clinical predictors in the univariate analysis. The top ten identified predictors were obtained by ML models, for predicting interventions and mortality, from the training dataset. The prediction of interventions includes death in non-intervention patients, validated with high accuracy (96%/98%), the area under the receiver-operating-characteristic curve (0.90/0.98), and positive likelihood ratios (22.3/69.8), respectively. The post-test probabilities in the test set were 55.4% and 71.6%, respectively, which were considerably superior to existing prognostic scores. The ML model, for predicting mortality in intervention patients, performed better or equally with prognostic scores. Conclusions: ML, using admission clinical predictors, can accurately predict therapeutic interventions and mortality in patients with AP.

• acute pancreatitis
• probiotics
• severe colitis
• toxic megacolon

• Acute pancreatitis
• Infected pancreatic necrosis
• Minimally invasive treatment
• Randomized controlled trial

• Acute Disease
• Hospitalization
• Humans
• Pancreatitis/diagnosis
• Pancreatitis/etiology
• Pancreatitis/therapy
• Quality Indicators, Health Care
• Retrospective Studies

Background: Pain management is an important priority in the treatment of acute pancreatitis (AP). Current evidence and guideline recommendations are inconsistent on the most effective analgesic protocol. This systematic review and meta-analysis of randomised controlled trials (RCTs) aimed to compare the safety and efficacy of analgesics for pain relief in AP.

Methods: A literature search was performed to identify all RCTs assessing analgesics in patients with AP. The primary outcome was the number of participants who needed rescue analgesia. Study quality was assessed using Jadad score. Pooled odds ratios (ORs) or weighted mean differences (WMDs) with 95% confidence intervals (CI) were analysed using a random-effects model.

Results: Twelve studies comprising 699 patients with AP (83% mild AP) were analysed. The tested analgesics significantly decreased the need for rescue analgesia (3 studies, OR.36, 95% CI 0.21 to 0.60) vs. placebo or conventional treatment. The analgesics also improved the pain score [Visual Analogue Scale (Δ-VAS)] at 24 h (WMD 18.46, 0.84 to 36.07) and by the 3rd to 7th days (WMD 11.57, 0.87 to 22.28). Opioids vs. non-opioids were associated with a decrease in the need for rescue analgesia (6 studies, OR 0.25, 95% CI 0.07 to 0.86, p = 0.03) but without significance in pain score. In subgroup analyses, opioids were similar to non-steroidal anti-inflammatory drugs (NSAIDs) regarding the primary outcome (4 studies, OR 0.56, 95% CI 0.24 to 1.32, p = 0.18). There were no significant differences in other clinical outcomes and rate of adverse events. Other studies, comparing epidural anaesthesia vs. patient-controlled analgesia and opioid (buprenorphine) vs. opioid (pethidine) did not show significant difference in primary outcome. Study quality issues significantly contributed to overall study heterogeneity.

Conclusions: NSAIDs and opioids are equally effective in decreasing the need for rescue analgesia in patients with mild AP. The relative paucity of trials and high-quality data in this setting is notable and the optimal analgesic strategy for patients with moderately severe and severe AP still requires to be determined.

• acute pancreatitis
• analgesics
• meta-analysis
• pain management
• randomised-controlled trial

Although the “Step-up” strategy is the primary surgical treatment for infected pancreatic necrosis, it is not suitable for all such patients. The “One-step” strategy represents a novel treatment, but the safety, efficacy, and long-term follow-up have not yet been compared between these two approaches.

To compare the safety, efficacy, and long-term follow-up of two surgical approaches to provide a reference for infected pancreatic necrosis treatment.

This was a retrospective analysis of infectious pancreatic necrosis patients who underwent “One-step” or “Step-up” necrosectomy at Xuan Wu Hospital, Capital Medical University, from May 2014 to December 2020. The primary outcome was the composite endpoint of severe complications or death. Patients were followed up every 6 mo after discharge until death or June 30, 2021. Statistical analysis was performed using SPSS 21.0 and GraphPad Prism 8.0, and statistical significance was set at P < 0.05.

One-hundred-and-fifty-eight patients were enrolled, of whom 61 patients underwent “One-step” necrosectomy and 97 patients underwent “Step-up” necrosectomy. During the long-term follow-up period, 40 patients in the “One-step” group and 63 patients in the “Step-up” group survived. The time from disease onset to hospital admission (53.69 ± 38.14 vs 32.20 ± 20.75, P < 0.001) and to initial surgical treatment was longer in the “Step-up” than in the “One-step” group (54.38 ± 10.46 vs 76.58 ± 17.03, P < 0.001). Patients who underwent “Step-up” necrosectomy had a longer hospitalization duration (65.41 ± 28.14 vs 52.76 ± 24.71, P = 0.02), and more interventions (4.26 ± 1.71 vs 3.18 ± 1.39, P < 0.001). Postoperative inflammatory indicator levels were significantly lower than preoperative levels in each group. Although the incisional hernia incidence was higher in the “One-step” group, no significant difference was found in the composite outcomes of severe complications or death, new-onset organ failure, postoperative complications, inflammatory indicators, long-term complications, quality of life, and medical costs between the groups (P > 0.05).

Compared with the “Step-up” approach, the “One-step” approach is a safe and effective treatment method with better long-term quality of life and prognosis. It also provides an alternative surgical treatment strategy for patients with infected pancreatic necrosis.

• Acute pancreatitis
• Follow-up
• Infectious pancreatic necrosis
• Safety and efficacy
• Surgical approach

• Digestive endoscopy
• incidence of postoperative complications
• meta-analysis
• necrotizing pancreatitis
• surgery

• Endoscopic treatment
• Lumen-apposing metal stents
• Pancreatic pseudocyst
• Walled-off necrosis

• adult intensive & critical care
• minimally invasive surgery
• pancreatic disease

• Drainage
• Hospitalization
• Humans
• Length of Stay
• Pancreatitis/therapy
• Paracentesis/adverse effects

• Natural Science Foundation of Anhui Province
• National Outstanding Youth Science Fund Project of National Natural Science Foundation of China

Despite existing evidence-based practice guidelines for the management of biliary acute pancreatitis (AP), the clinical compliance with recommendations is overall poor. Studies in this field have identified significant discrepancies between evidence-based recommendations and daily clinical practice. The most commonly reported gaps between clinical practice and AP guidelines include the indications for CT scan, need and timing of artificial nutritional support, indications for antibiotics, and surgical/endoscopic management of biliary AP. The MANCTRA-1 (coMpliAnce with evideNce-based cliniCal guidelines in the managemenT of acute biliaRy pancreAtitis) study is aiming to identify the areas for quality improvement that will require new implementation strategies. The study primary objective is to evaluate which items of the current AP guidelines are commonly disregarded and if they correlate with negative clinical outcomes according to the different clinical presentations of the disease. We attempt to summarize the main areas of sub-optimal care due to the lack of compliance with current guidelines to provide the basis for introducing a number of bundles in AP patients’ management to be implemented during the next years. The MANCTRA-1 study is an international multicenter, retrospective cohort study with the purpose to assess the outcomes of patients admitted to hospital with a diagnosis of biliary AP and the compliance of surgeons worldwide to the most up-to-dated international guidelines on biliary AP. ClinicalTrials.Gov ID Number: NCT04747990, Date: February 23, 2021. Protocol Version V2.2.

• Acute pancreatitis
• Biliary pancreatitis
• Global surgery
• Guidelines compliance
• Study protocol
• Sub-optimal care

• acute pancreatitis
• pancreaticoduodenectomy
• periampullary tumor
• total pancreatectomy

• Case report
• Disconnected pancreatic duct syndrome
• External drainage
• Internal drainage
• Pancreatic leakage
• Surgery
• Systemic inflammatory response syndrome

• minimally invasive
• multidisciplinary team
• optimally
• severe acute pancreatitis
• staged management

• Acute pancreatitis
• Guideline adherence
• International survey
• Nutrition
• Practice patterns
• Tube feedings

• acute pancreatitis
• candidemia
• intra-abdominal fungal infection

• Cholangitis
• ERCP
• EUS
• biliary leak
• cholecystitis
• pancreatitis

• Macrophage migration inhibitory factor
• Prediction
• Revised Atlanta classification
• Severe acute pancreatitis

• acute respiratory distress syndrome
• management
• pancreatitis
• risk
• treatment

• APACHE
• Adult
• Biomarkers
• Female
• Heart Rate
• Humans
• Logistic Models
• Male
• Middle Aged
• Pancreatitis/blood
• Pancreatitis/epidemiology
• Respiratory Distress Syndrome/blood
• Respiratory Distress Syndrome/epidemiology
• Respiratory Rate
• Retrospective Studies
• Risk Factors

• Diagnosis
• Guidelines
• Severe pancreatitis

• CRP
• IL-6
• TNF-α
• duodenoscopy
• laparoscopy
• severe acute pancreatitis complicated with pancreatic pseudocyst

• Acute pancreatitis (AP)
• complications
• diagnostic criteria
• management
• pathogenetic mechanism
• prognosis