Current Management of the Most Common Complications in Acute Pancreatitis. A Systematic Review
DOI:
https://doi.org/10.55204/trc.v5i2.e440Keywords:
Pancreatitis, pseudocyst, abscess, drainageAbstract
Introduction: Acute pancreatitis is one of the most common reasons for consultation, characterized by the sudden inflammation of the pancreas; the etiology is variable but mainly associated with biliary pathology and alcoholism; most patients present with a mild picture, so its diagnosis is made by combining clinical, laboratory parameters, and imaging studies. However, it can evolve into a severe condition, such as necrosis, pseudocyst, or pancreatic abscess; its management can be by surgical, laparoscopic, or endoscopic drainage.
Objective: To know the current management of the most common complications in acute pancreatitis employing a systematic review.
Methods: A systematic review was conducted using information from PubMed, SciELO, Elsevier, Google Scholar, and Scopus databases. In addition, the Mendeley Reference Manager was used, taking into consideration the recommendations of the PRISMA 2020 Guidelines.
Results: After the search for information, 45 articles were obtained, of which, based on the inclusion and exclusion criteria, 40 articles were analyzed for this review.
Conclusions: Diagnosis or suspicion should be made early to avoid complications. The incidence is 20% in necrosis, 18.5% in pseudocyst, and 5% in pancreatic abscess. Nevertheless, once established, management will depend on some criteria, where general condition, time, size, location, and comorbidities are considered, either to start pharmacological treatment or, if required, minimally invasive surgical approaches that have shown to have a lower mortality rate.
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References
Pilamunga Lema CL, Villafuerte Morales JE. Diagnosis and Treatment of Acute Pancreatitis: Bibliographic Review. ESPOCH Congresses: The Ecuadorian Journal of STEAM. 2021;1(6):44–55.
D. Lorenzo AD. Pancreatitis aguda. Prensa Med [Internet]. 2022;26(1):1–8. Available from: https://doi.org/10.1016/S1636-5410(22)46039-9
Russo Lozano J, Sánchez OB, Oñate Silva I, Espinoza Díaz C. Incidencia y características epidemiológicas de la pancreatitis aguda. Centro Latinoamericano de Estudios Epidemiológicos y Salud Social Departamento de Investigaciones “Dr Carlos J Finlay y de Barré” [Internet]. 2020;8–11. Available from: https://www.revistaavft.com/images/revistas/2020/avft_4_2020/5_incidencias_caracter isticas.pdf
Bansal A, Gupta P, Singh H, Samanta J, Mandavdhare H, Sharma V, et al. Gastrointestinal complications in acute and chronic pancreatitis. JGH Open [Internet]. 2019;3(6):450–5. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6891019/
Mandalia A, Wamsteker EJ, DiMagno MJ. Recent advances in understanding and managing acute pancreatitis. F1000Res [Internet]. 2019;7(0):959. Available from: https://pubmed.ncbi.nlm.nih.gov/30026919/
Garber A, Frakes C, Arora Z, Chahal P. Mechanisms and management of acute pancreatitis. Gastroenterol Res Pract. 2018;2018:1–8.
Bustamante Durón D, García Laínez A, Umanzor García W, Leiva Rubio L, Barrientos Rosales A, Diek Romero L. Acute Pancreatitis: Current Evidence. MedPub Journals [Internet]. 2018;14:4. Available from: www.archivosdemedicina.com
Alberto Puerto Lorenzo J, Torres Aja L, Cabanes Rojas E, Aldereguía Lima G. Pseudoquiste de páncreas. Presentación de un caso y revisión de la literatura Pancreatic Pseudocyst. Case Report and Literature Review. Revista Finlay. 2020;10(3):24–34.
García Rodríguez IO, Alonso AM, Díaz VF, Fernández ML. Absceso pancreático en paciente con pancreatitis alcohólica crónica. Revista Espanola de Quimioterapia [Internet]. 2020;33(6):462–3. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7712342/pdf/revespquimioter-33- 462.pdf
Weiss FU, Laemmerhirt F, Lerch MM. Acute pancreatitis: Genetic risk and clinical implications. J Clin Med. 2021;10(2):1–13.
Guidi M;, Curvale C;, Pasqua A;, Hwang H, Pires H;, Basso S;, et al. Actualización en el manejo inicial de la pancreatitis aguda. Redalyc- Acta Gastroenterológica Latinoamerican [Internet]. 2019;49(4):2429–1119. Available from: https://www.redalyc.org/articulo.oa?id=199362054003
Mayorga-Garcés A, Otero-Regino W, Parga-Bermúdez J. Nutrition in acute pancreatitis: New concepts for an old problem. Rev Colomb Gastroenterol. 2020 Oct 1;35(4):465– 70.
Stern J, El Kalai A, Montravers P. Pancreatitis aguda: diagnóstico, tratamiento y pronóstico. EMC - Anestesia-Reanimación [Internet]. 2023 Nov;49(4):1–18. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1280470323483521
Noor Sadiq, Syed Wasif Gillani, Dalia Al Saeedy, Joud Rahmoun, Durah Shaban, Kholoud Kotait SJ, Department. Clinical Review of Acute, Recurrent, and Chronic Pancreatitis: Recent Updates of 2013–2019 Literature. Asian Journal of Pharmaceutical and Clinical Research [Internet]. 2020;12(2):112–23. Available from: https://www.jpbsonline.org/downloadpdf.asp?issn=0975- 7406;year=2020;volume=12;issue=2;spage=112;epage=123;aulast=Sadiq;type=2
Boxhoorn L, Fockens P, Besselink MG, Bruno MJ, van Hooft JE, Verdonk RC, et al. Endoscopic Management of Infected Necrotizing Pancreatitis: an Evidence-Based Approach. Curr Treat Options Gastroenterol [Internet]. 2018;16(3):333–44. Available from: https://link.springer.com/article/10.1007/s11938-018-0189-8
Rana SS. An overview of walled-off pancreatic necrosis for clinicians. Expert Rev Gastroenterol Hepatol [Internet]. 2019 Apr 3;13(4):331–43. Available from: https://www.tandfonline.com/doi/full/10.1080/17474124.2019.1574568
Jha AK, Goenka MK, Kumar R, Suchismita A. Endotherapy for pancreatic necrosis: An update. JGH Open [Internet]. 2019;3(1):80–8. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6386747/pdf/JGH3-3-80.pdf
Baron TH, DiMaio CJ, Wang AY, Morgan KA. American Gastroenterological Association Clinical Practice Update: Management of Pancreatic Necrosis. Gastroenterology [Internet]. 2020 Jan 1;158(1):67-75.e1. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0016508519412936
Trikudanathan G, Wolbrink DRJ, van Santvoort HC, Mallery S, Freeman M, Besselink MG. Current Concepts in Severe Acute and Necrotizing Pancreatitis: An Evidence- Based Approach. Gastroenterology. 2019 May 1;156(7):1994-2007.e3.
Fuentes CF, Córdoba Guzmán AC, Daza Castro EM, Aponte D, González C, Sabbagh LC. Terapia E-VAC como tratamiento de complicaciones en cirugía gastrointestinal en centro de referencia de gastroenterología en Colombia: Serie de casos. Revista de Gastroenterología del Perú [Internet]. 2023 Jun 30;43(2):e1472. Available from: https://revistagastroperu.com/index.php/rgp/article/view/1472
Thomas E Clancy, Stanley W Ashley, John R Saltzman, Wenliang Chen. Pancreatic debridement. UpToDate [Internet]. 2022 Jun 30 [cited 2023 Nov 11];1–24. Available from: https://www.uptodate.com/contents/pancreatic- debridement/print?search=radiology&topicRef=5651&source=see_link
Thomson JE, Van Dijk SM, Brand M, Van Santvoort HC, Besselink MG. Managing infected pancreatic necrosis. Chirurgia (Romania). 2018;113(3):291–9.
Rashid MU, Hussain I, Jehanzeb S, Ullah W, Ali S, Jain AG, et al. Pancreatic necrosis: Complications and changing trend of treatment. World J Gastrointest Surg [Internet]. 2019;11(4):198–217. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6513789/pdf/WJGS-11-198.pdf
Luis E. Cuéllar Ponce de León. Tratamiento-antibiótico-en-pancreatitis. Clinica Infectologica - UNFV [Internet]. 2022 [cited 2023 Nov 11];19–23. Available from: http://clinicainfectologica2hnc.webs.fcm.unc.edu.ar/files/2018/03/Tratamiento- antibi%C3%B3tico-en-pancreatitis.pdf
Garret C, Canet E, Corvec S, Boutoille D, Péron M, Archambeaud I, et al. Impact of prior antibiotics on infected pancreatic necrosis microbiology in ICU patients: a retrospective cohort study. Ann Intensive Care. 2020 Dec 1;10(1).
Misra D, Sood T. Pancreatic Pseudocyst Pathophysiology Histopathology. Stat Pearls [Internet]. 2020;1–6. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557594/
Banu P, Socea B, Balan D, Sandu V, Onicel T, Silaghi A, et al. The customized therapeutic approach of a giant pancreatic pseudocyst. A case report and literature review. Journal of Mind and Medical Sciences. 2022 Apr 10;9(1):193–200.
Nealon WH, Walser E, Adams DB, Yeo CJ, Gadacz TR, Vogel SB, et al. Surgical management of complications associated with percutaneous and/or endoscopic management of pseudocyst of the pancreas. Ann Surg [Internet]. 2020;241(6):948–60. Available from:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1357174/pdf/20050600s00012p948.p df
Raj J Shah, Douglas G Adler, Kristen M. Robson. Approach to walled-off pancreatic fluid collections in adults. UpToDate [Internet]. 2022 Sep 29 [cited 2023 Nov 11];1–14. Available from: https://www.uptodate.com/contents/approach-to-walled-off-pancreatic- fluid-collections-in-adults?search=seudoquiste de pancreatitis&source=search
Baez DK, Angel GD, Pedraza M, Cabrera LF. Manejo endoscópico de complicaciones locales por pancreatitis aguda: Reporte de caso y revisión de la literatura. Annals of Mediterranean Surgery. 2021 Jun 30;4(1):13–8.
Prytkov F, Yurkin D. Pancreatic abscess: a modern look at an old problem. Ukrainian Scientific Medical Youth Journal. 2022 Mar 27;128(1):42–9.
Grinsven J Van, Van Dijk SM, Dijkgraaf MG, Boermeester MA, Bollen TL, Bruno MJ, et al. Postponed or immediate drainage of infected necrotizing pancreatitis (POINTER trial): Study protocol for a randomized controlled trial. Trials. 2019 Apr 25;20(1).
Jagielski M, Smoczyński M, Szeliga J, Adrych K, Jackowski M. Various endoscopic techniques for treatment of consequences of acute necrotizing pancreatitis: Practical updates for the endoscopist. Vol. 9, Journal of Clinical Medicine. MDPI; 2020.
Bang JY, Arnoletti JP, Holt BA, Sutton B, Hasan MK, Navaneethan U, et al. An Endoscopic Transluminal Approach, Compared With Minimally Invasive Surgery, Reduces Complications and Costs for Patients With Necrotizing Pancreatitis. Gastroenterology [Internet]. 2019 Mar 1;156(4):1027-1040.e3. Available from: https://linkinghub.elsevier.com/retrieve/pii/S001650851835279X
Barrantes Astorga GJ, Varela Moreno AC, González Houdelath K. Pseudoquiste pancréatico. Revista Medica Sinergia. 2020 Oct 1;5(10):e585.
Michael O, Derick K, Srikant S, Xavier BF, Darshit D. Cystocolostomy as an unusual approach to recurrent pancreatic pseudocyst in a Ugandan male with dense hepatogastroduodenal adhesions: A case report. Int J Surg Case Rep. 2021 Nov 1;88.
Agalianos C, Passas I, Sideris I, Davides D, Dervenis C. Review of management options for pancreatic pseudocysts. Vol. 2018, Translational Gastroenterology and Hepatology. AME Publishing Company; 2018.
van Brunschot S, van Grinsven J, van Santvoort HC, Bakker OJ, Besselink MG, Boermeester MA, et al. Endoscopic or surgical step-up approach for infected necrotising pancreatitis: a multicentre randomised trial. The Lancet. 2018 Jan 6;391(10115):51–8.
Wu YJ, Chen YY, Hsieh YC. Unusual Pancreatic Abscess Secondary to Embedded Fish Bone: A Challenging Clinical Scenario. Diagnostics. 2022 Dec 1;12(12).
Rajkumar K, Mahmoud A, Abdalla M, Grossman M. Pancreatic Abscess: An Infection Occurring with Minimal Tissue Present. Case Reports in Clinical Medicine. 2023;12(05):113–8.
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