Treatment of Acute Pancreatitis: An Attempted Historical Review

doi:10.1159/000255465

Pancreatology

Volume 10, Issues 2–3, June 2010, Pages 134-141

https://doi.org/10.1159/000255465 Get rights and content

Abstract

This attempt at a historical review of the treatment of acute pancreatitis summarizes the findings of studies carried out in decades long past and shows their impact on the therapy of this disease today. It identifies in retrospect the correct avenues of research and the blind alleys, and describes the ebb and flow of interest in various forms of management. Acquaintance with the work of previous investigators may prevent the unnecessary rediscovery of old principles of treatment. Not all of the studies discussed can be found with search engines: they come from the author's personal library, collected over his 40 years as an active pancreatologist, and from the knowledge of the early literature bequeathed to him by his teachers and mentors.

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Cited by (12)

Metabolic Sequelae: The Pancreatitis Zeitgeist of the 21st Century
2023, Gastroenterology
Holistic management of pancreatitis means that gastroenterologists in the 21st Century should think beyond improving in-hospital outcomes of pancreatitis alone. In particular, there is considerable room for optimizing the management of new-onset diabetes, exocrine pancreatic insufficiency, and other metabolic sequelae of pancreatitis. The present article provides state-of-the-art information on classification, terminology, and burden of the common sequelae of pancreatitis. A high-risk group of patients with pancreatitis is identified, which is positioned to benefit the most from the metabolic sequelae surveillance program introduced in this article. The program involves continuous follow-up after pancreatitis diagnosis, with the focus on early identification of new-onset diabetes after pancreatitis and exocrine pancreatic insufficiency. The metabolic sequelae surveillance program is scalable and has the potential to reduce the burden of pancreatitis through tertiary prevention in the decades to come.
Peritoneal dialysis beyond kidney failure?
2018, Journal of Controlled Release
Citation Excerpt :
Two studies showed non-significant improvements in mortality with PD treatment [49,50], while the majority demonstrated a lack of clinical improvement [51–56], even when a trypsin inhibitor aprotinin was included in the dialysate [42,57]. Various meta-analyses and systematic reviews have concluded that PD is not associated with significant clinical benefit in this indication [58–60], which is reflected in some guidelines [61]. While opposing views have recently emerged, these are either based on a specific animal model [62] or on clinical studies comparing clinical variables pre- and post-PD treatment without an appropriate control group [63,64].
Compared to extracorporeal modalities, peritoneal dialysis (PD) is less invasive and more cost-effective, wherein blood is dialyzed intra-corporeally against a solution instilled in the peritoneal cavity. Although PD is mainly indicated for patients with end-stage renal failure, it has also been used for several non-renal indications. The aim of this review is to provide an overview of the role of PD beyond kidney failure. The alternative indications of PD include hypothermia, congestive heart failure, hyperammonemia and poisoning with xenobiotics. The use of PD as a treatment for acute pancreatitis and psoriasis was initially proposed but could not be established; these indications are therefore classified as historically relevant. Recent developments have led to a potential application of PD during the management of stroke and as an oxygenation therapy with the use of oxygen carriers. Novel colloid-based dialysates with improved functionality with respect to detoxification and oxygenation are currently underway, though their efficacy has so far only been demonstrated in pre-clinical settings. Finally, insight into potential future developments of PD is given. Characterization studies are proposed to better understand the fate of non-recovered carriers following dialysate removal, their efficacy following multiple administrations and potential immune response to optimize their formulation, enabling their clinical translation.
Early crystalloid fluid volume management in acute pancreatitis: Association with mortality and organ failure
2011, Pancreatology
Aims: Guidelines recommend aggressive fluid resuscitation in patients with acute pancreatitis (AP) to minimize organ failure. This study aimed to determine whether early crystalloid fluid management is associated with mortality and/or critical care. Methods: 9,489 AP patients aged 618 years were categorized into four study groups: ventilation, hemodialysis, a combination of ventilation and hemodialysis, and neither ventilation nor hemodialysis. We analyzed demographics, mortality, comorbidities, complications, AP severity, surgery of the biliary/pancreatic system, and fluid volume (FV) during the initial 48 h (FV48) and during hospitalization (FVH), and calculated the FV ratio (FVR) as FV48/FVH. The impact of FV48 and FVR on mortality and the care process was assessed according to AP severity. Results: 1.1% of AP patients received ventilation, 1.7% received hemodialysis and 1.0% received both treatments. FV48 and FVR were higher in patients requiring ventilation compared with those not requiring ventilation. A high FV48 increased mortality and a high FVR decreased mortality in patients with severe AP. A high FV48 required ventilation in patients with severe AP, which was independently associated with mortality. Conclusion: Since relatively too much or too little early FV is associated with mortality, FV should be continuously monitored and managed according to AP severity.
A novel model of severe gallstone pancreatitis: Murine pancreatic duct ligation results in systemic inflammation and substantial mortality
2010, Pancreatology
Background: Suitable experimental models of gallstone pancreatitis with systemic inflammation and mortality are limited. We developed a novel murine model of duct-ligation-induced acute pancreatitis associated with multiorgan dysfunction and severe mortality. Methods: Laparotomy was done on C57/BL6 mice followed by pancreatic duct (PD) ligation, bile duct (BD) ligation without PD ligation, or sham operation. Results: Only mice with PD ligation developed acute pancreatitis and had 100% mortality. Pulmonary compliance was significantly reduced after PD ligation but not BD ligation. Bronchoalveolar lavage fluid neutrophil count and interleukin-1 β concentration, and the plasma creatinine level, were significantly elevated with PD ligation but not BD ligation. Pancreatic nuclearfactor kB (p65) and activator protein 1 (c-Jun) were activated within 1 h of PD ligation. Conclusion: PD-ligation-induced acute pancreatitis in mice is associated with systemic inflammation, acute lung injury, multiorgan dysfunction and death. The development of this novel model is an exciting and notable advance in the field.
Rosmarinic acid attenuates sodium taurocholate-induced acute pancreatitis in rats by inhibiting nuclear factor-κB Activation
2015, American Journal of Chinese Medicine
Association between severity and the determinant-based classification, Atlanta 2012 and Atlanta 1992, in acute pancreatitis
2015, Medicine (United States)

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Treatment of Acute Pancreatitis: An Attempted Historical Review

Abstract

Am J Surg

Lancet

Am J Gastroenterol

Lancet

Lancet

Gastroenterology

Protective effects of glucagon. Gastroenterology

Gastroenterology

Gastroenterology

Gastroenterology

Gastroenterology

Acute pancreatitis at its centenary. The contribution of Reginald Fitz

Ann Surg

Forgotten pioneers of pancreatic surgery

Beyond the favorite few. Ann Surg

Acute pancreatitis

A historical perspective. Pancreas

Neuere Anschauungen über die akute Pankreasnekrose und ihre Behandlung

Arch Klin Chir

Retrojection of bile into the pancreas, a cause of acute hemorrhagic pancreatitis

Johns Hopkins Hosp Bull

Chirurgie des Pankreas

Arch Klin Chir

Consideration of the lethal factors in acute pancreatitis

Arch Surg

Zur Diagnose und Therapie der akuten Pankreasnekrose

Bruns' Beitr

Acute pancreatitis

Surgery

Determination of necrosis in necrotizing pancreatitis

Br J Surg

Umstrittene Fragen bei akuter Pankreasnekrose (Aktuelles zur Aetiologie, Diagnose und Behandlung der akuten Pankreasnekrose)

Wien Klin Wochenschr

Acute pancreatitis. A statistical review of 307 established cases of acute pancreatitis

Surg Gynecol Obstet

Le traitement des pancréatitesaiguësnécrosantesparl'ablation chirurgicale précoce des portions nécrosées

Chirurgie (Paris)

Notre expérience de la pancréatite aiguë

Chirurgie (Paris)

Sur une série de 100 cas de pancréatite aiguë graves opérés précocement

Chirurgie (Paris)

Total pancreatectomy in the treatment of acute necrotising and hemorrhagic pancreatitis. Indications — technique

Langenbecks Arch Chir

Vorzeitige Operation bei akuter hämorrhagisch-nekrotisierender Pankreatitis

Dtsch Med Wochenschr

Verzögerte Operation bei akuter Pankreatitis

Chirurg

Management of pancreatic necrosis and pancreatic abscess

The use of human serum albumin in the management of acute pancreatitis. Experimental and clinical observations

Gastroenterology

Treatment of acute pancreatitis with albumin and whole blood

Arch Surg

Infected pancreatic necrosis and peripancreatic fluid collections: serendipitous response to antibiotics and medical therapy in three patients

Pancreas

Severe acute pancreatitis: nonsurgical treatment of infected necroses

Pancreas

Review article: transluminal endoscopic debridement of organized pancreatic necrosis — e first step towards natural orifice transluminal endoscopic surgery

Aliment Pharmacol Ther

Prognostic factors in patients undergoing surgery for severe necrotizing pancreatitis

World J Surg

Experimental model for peritoneal dialysis in small laboratory animals

Clin Nephrol

Continuous peritoneal dialysis as treatment of acute experimental pancreatitis in the rat

I. Effect on length and rate of survival. Dig Dis Sci

Experimental acute pancreatitis in dogs

I. Hypotensive effect induced by pancreatic exudate. Scand J Gastroenterol

Hypotension and release of kinin-forming enzyme into ascitic fluid exudate during experimental pancreatitis in dogs

Ann Surg

Experimental acute pancreatitis in dogs. IV. The relationship between phospholipase A and the histamine-releasing hypotensive effects of pancreatic exudate

Scand J Gastroenterol

Experimental acute pancreatitis in dogs. II. Histamine release induced by pancreatic exudate

Scand J Gastroenterol

Continuous peritoneal dialysis as treatment of acute experimental pancreatitis in the rat. II. Analysis of its beneficial effect

Dig Dis Sci

Peritoneal dialysis in the treatment of acute alcoholic pancreatitis

Surg Gynecol Obstet

The role of peritoneal lavage in the prediction and treatment of severe acute pancreatitis

Ann Roy Coll Surg Engl