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Curr Opin Crit Care. 2007 Apr;13(2):200-6.

Management of severe acute pancreatitis: it's all about timing.

Author information

1
Department of Surgery, University Medical Center Utrecht, The Netherlands. m.besselink@umcutrecht.nl

Abstract

PURPOSE OF REVIEW:

This study provides an update on the treatment of severe acute pancreatitis (SAP) with emphasis on nutrition, infection-prophylaxis, biliary pancreatitis, surgical intervention and new randomized controlled trials.

RECENT FINDINGS:

The most relevant new insights are: (i) early enteral nutrition in SAP is not only capable of reducing infectious complications but may also reduce mortality; (ii) there is increasing evidence that antibiotic-prophylaxis is not capable of preventing infectious complications in SAP; (iii) probiotic-prophylaxis is being considered as an alternative with promising experimental results; (iv) in biliary pancreatitis, early endoscopic retrograde cholangiography with sphincterotomy (within 48 h) is beneficial in case of ampullary obstruction, although it may be withheld in the event of negative endoscopic ultrasound; (v) surgical intervention for infected (peri-)pancreatic necrosis is increasingly being postponed; (vi) minimally invasive strategies are being considered as a full alternative for necrosectomy by laparotomy in infected (peri-)pancreatic necrosis; (vii) the Atlanta classification should no longer be used to describe computed tomography findings in acute pancreatitis; and (viii) only five randomized controlled trials of patients with acute pancreatitis are currently registered in the international trial registries.

SUMMARY:

Timing of intervention is becoming increasingly important in SAP management.

PMID:
17327743
DOI:
10.1097/MCC.0b013e328015b8af
[Indexed for MEDLINE]

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