[The pancreas and the biliary tract. Acute pancreatitis]

Abstract

The present article reviews the conclusions of the most interesting studies on acute pancreatitis presented at Digestive Disease Week 2011. Specific prognostic systems for acute pancreatitis show moderate accuracy in predicting outcome, which may be improved by step-up combination rules. The presence of systemic inflammatory response syndrome seems to be a better marker of severity than the bedside index for severity in acute pancreatitis (BISAP) score. Admission hematocrit, 24 h creatinine and 24 h BUN seem to predict the development of pancreatic necrosis. Cardiovascular disease may be associated with an increased risk of severe post-endoscopic retrograde cholangiopancreatography (ERCP) acute pancreatitis. Prognostic abdominal computed tomography scan should be avoided until the second day of admission. Endoscopic necrosectomy may be associated with shorter length of hospital stay, similar radiologic success and probably a lower incidence of complications than open necrosectomy. Combination therapy involving endoscopic plus percutaneous drainage is associated with good long-term outcomes. Outcome is better in patients who receive more than one third of their 72 h total fluid therapy within the first 24 h. The best predictor of a high need for fluid therapy in the first 48 h is leukocyte count.