Practical guidelines for acute pancreatitis.
Pancreatology. 2010;10(5):523-35
Authors: Pezzilli R, Zerbi A, Di Carlo V, Bassi C, Delle Fave GF,
INTRODUCTION: The following is a summary of the official guidelines of t…

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Prediction of mortality in acute pancreatitis: a systematic review of the published evidence.

Pancreatology. 2009;9(5):601-14

Authors: Gravante G, Garcea G, Ong SL, Metcalfe MS, Berry DP, Lloyd DM, Dennison AR

Objective: In this review, we focus on studies that examined such prognostic indices in relation to predicting a fatal outcome from pancreatitis. Summary Background Data: Acute pancreatitis (AP) is a common emergency, and early identification of high-risk patients can be difficult. For this reason, a plethora of different prognostic variables and scoring systems have been assessed to see if they can reliably predict the severity of pancreatitis and/or subsequent mortality. Methods: All studies that focused on AP, including retrospective series and prospective trials, were retrieved and analysed for factors that could influence mortality. Articles that analysed factors influencing the severity of the disease or the manifestation of disease-related complications were excluded. Results: 58 articles meeting the inclusion criteria were identified. Among the various factors investigated, APACHE II seemed to have the highest positive predictive value (69%). However, most prognostic variables and scores showed high negative predictive values but suboptimal values for positive predictive power. Conclusions: Despite the proliferation of scoring systems for grading AP, none are ideal for the prediction of mortality. With the exception of the APACHE II, the other scores and indexes do not have a high degree of sensitivity, specificity and predictive values.

PMID: 19657215 [PubMed - indexed for MEDLINE]

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Cystic lesions of the pancreas. A diagnostic and management dilemma.

Pancreatology. 2008;8(3):236-51

Authors: Garcea G, Ong SL, Rajesh A, Neal CP, Pollard CA, Berry DP, Dennison AR

BACKGROUND/AIMS: Due to enhanced imaging modalities, pancreatic cysts are being increasingly detected, often as an incidental finding. They comprise a wide range of differing underlying pathologies from completely benign through premalignant to frankly malignant. The exact diagnostic and management pathway of these cysts remains problematic and this review attempts to provide an overview of the pathology underlying pancreatic cystic lesions and suggests appropriate methods of management. METHODS: A search was undertaken with a Pubmed database to identify all English articles using the keywords 'pancreatic cysts', 'serous cystadenoma', 'intraductal papillary mucinous tumour', 'pseudocysts', 'mucinous cystic neoplasm' and 'solid pseudopapillary tumour'. RESULTS: The mainstay of assessment of pancreatic cysts is cross-sectional imaging incorporating CT and MRI. Fine-needle aspiration (FNA) (often with endoscopic ultrasound) may provide valuable additional information but can lack sensitivity. Symptomatic cysts, increasing age and multilocular cysts (with a solid component and thick walls) are predictors of malignancy. A raised cyst aspirate CEA, CA 19-9 and mucin content (including abnormal cytology), if present, can accurately distinguish premalignant and malignant cysts from benign ones. CONCLUSION: In summary, all patients with pancreatic cystic lesions, whether asymptomatic or symptomatic, must be thoroughly investigated to ascertain the underlying nature of the cyst. Small asymptomatic cysts (<3 cm) with no suspicious features on imaging or FNA may be safely followed up. Follow-up should continue for at least 4 years, with a repeat FNA if needed. An algorithm for the management of pancreatic cystic tumours is also suggested. and IAP.

PMID: 18497542 [PubMed - indexed for MEDLINE]

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Pancreatic pain: a mini review.

Pancreatology. 2008;8(3):230-5

Authors: Cruciani RA, Jain S

Pain management is one of the corner stones in the treatment of pancreatitis. There are a variety of pharmacological and non-pharmacological strategies to manage the symptoms. Recognizing the type of pain, nociceptive or neuropathic, is essential for appropriate treatment. The pharmacological armamentarium currently available is substantial and includes adjuvant analgesics, non-steroidal anti-inflammatories, and opioids that are customized to the etiology of the pain. When pain relief is suboptimal with pharmacological interventions, celiac block and other interventions should be considered. In acute pancreatitis the use of opioids is widely accepted while its use in chronic states is more controversial. When opioids are utilized, special care has to be taken for the assessment of indicators of misuse or abuse. A multidisciplinary approach to manage these complex patients will result in a high yield of success in controlling this and other symptoms. and IAP.

PMID: 18509251 [PubMed - indexed for MEDLINE]

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