Biliary pancreatitis (Part 1)

acute pancreatitisGallstones are the leading cause of acute pancreatitis (AP) in many Western and Asian countries, accounting for 34% to 54% of the 4.8 to 24.2 cases per 100,000 each year of the disease. Despite advances in intensive care management, the case fatality rate of severe AP is still approximately 10%.

Early endoscopic intervention has been increasingly used in the management of acute biliary pancreatitis (ABP). It allows the removal of the offending stone(s) and the establishment of biliary drainage. Observational data and, more importantly, four randomized controlled trials (RCTs) involving more than 800 patients have supported the use of endoscopic sphincterotomy (ES). In specialized centres, success rates exceed 90%. This article summarizes the results of these studies and describes the optimal approach to the management of ABP.

PROGNOSTIC FACTORS

The majority of patients with ABP experience relatively minor episodes, from which they recover within a week with conservative therapy. On the other hand, a significant proportion of patients with severe pancreatitis die during their initial hospitalization. Early and accurate identification of patients with severe AP is crucial, because they require and are likely to benefit from intensive medical management and early endoscopic therapy.

Assessment of the severity of AP has been accomplished by:

•    the presence of organ failure;

•    early prognostic indices; and

•    the presence of necrosis, abscesses and fluid collections, as visualized by dynamic contrast-enhanced computerized tomography (CT).

The development of organ failure is a reliable sign of severe pancreatitis. While criteria vary, it appears that the presence of respiratory failure (partial pressure of arterial oxygen less than 60 mmHg), renal failure (creatinine greater than 2 mg/dL [177 |lmol/L]), shock and gastrointestinal bleeding are the most important determinants of severe pancreatitis. Choose a perfect online pharmacy where you could be shopping for cialis super active online pharmacy here any time, being sure your medical conditions will be under your complete control every step of the way.

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