Document Detail

Evidence-based treatment of acute pancreatitis: a look at established paradigms.
MedLine Citation:
PMID:  16432347     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The management of acute pancreatitis (AP) is still based on speculative and unproven paradigms in many centers. Therefore, we performed an evidence-based analysis to assess the best available treatment.
METHODS: A comprehensive Medline and Cochrane Library search was performed evaluating the indication and timing of interventional and surgical approaches, and the value of aprotinin, lexipafant, gabexate mesylate, and octreotide treatment. Each study was ranked according to the evidence-based methodology of Sackett; whenever feasible, we performed new meta-analyses using the random-effects model. Recommendations were based on the available level of evidence (A=large randomized; B=small randomized; C=prospective trial).
RESULTS: None of the evaluated medical treatments is recommended (level A). Patients with AP should receive early enteral nutrition (level B). While mild biliary AP is best treated by primary cholecystectomy (level B), patients with severe biliary AP require emergency endoscopic papillotomy followed by interval cholecystectomy (level A). Patients with necrotizing AP should receive imipenem or meropenem prophylaxis to decrease the risk of infected necrosis and mortality (level A). Sterile necrosis per se is not an indication for surgery (level C), and not all patients with infected necrosis require immediate surgery (level B). In general, early necrosectomy should be avoided (level B), and single necrosectomy with postoperative lavage should be preferred over "open-packing" because of fewer complications with comparable mortality rates (level C).
CONCLUSIONS: While providing new insights into key aspects of AP management, this evidence-based analysis highlights the need for further clinical trials, particularly regarding the indications for antibiotic prophylaxis and surgery.
Stefan Heinrich; Markus Schäfer; Valentin Rousson; Pierre-Alain Clavien
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Publication Detail:
Type:  Journal Article; Meta-Analysis    
Journal Detail:
Title:  Annals of surgery     Volume:  243     ISSN:  0003-4932     ISO Abbreviation:  Ann. Surg.     Publication Date:  2006 Feb 
Date Detail:
Created Date:  2006-01-24     Completed Date:  2006-03-16     Revised Date:  2013-06-07    
Medline Journal Info:
Nlm Unique ID:  0372354     Medline TA:  Ann Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  154-68     Citation Subset:  AIM; IM    
Swiss HPB Center, Department of Visceral and Transplantation Surgery, University Hospital of Zurich, Zurich, Switzerland.
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MeSH Terms
Acute Disease
Anti-Bacterial Agents / therapeutic use
Antibiotic Prophylaxis
Aprotinin / therapeutic use
Enteral Nutrition
Evidence-Based Medicine
Gabexate / therapeutic use
Gastrointestinal Agents / therapeutic use
Imidazoles / therapeutic use
Imipenem / therapeutic use
Leucine / analogs & derivatives,  therapeutic use
Octreotide / therapeutic use
Pancreatitis / drug therapy,  surgery*
Pancreatitis, Acute Necrotizing / drug therapy,  surgery
Platelet Activating Factor / antagonists & inhibitors
Randomized Controlled Trials as Topic
Serine Proteinase Inhibitors / therapeutic use
Sphincterotomy, Endoscopic
Thienamycins / therapeutic use
Reg. No./Substance:
0/Anti-Bacterial Agents; 0/Gastrointestinal Agents; 0/Imidazoles; 0/Platelet Activating Factor; 0/Serine Proteinase Inhibitors; 0/Thienamycins; 39492-01-8/Gabexate; 61-90-5/Leucine; 74431-23-5/Imipenem; 83150-76-9/Octreotide; 9087-70-1/Aprotinin; 96036-03-2/meropenem; H14917M9YW/lexipafant
Comment In:
Ann Surg. 2006 Oct;244(4):637-8; author reply 638-9   [PMID:  16998381 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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