[Advances and perspectives in acute pancreatitis]

Area of Science:

• Gastroenterology
• Surgical Gastroenterology

Background:

• Biliary etiology, including biliary sludge and sphincter of Oddi dysfunction, is increasingly recognized as a primary cause of acute pancreatitis, previously termed idiopathic.
• Necrosis and secondary infection are critical determinants of acute pancreatitis prognosis.

Purpose of the Study:

• To review the etiology, diagnosis, and management of acute pancreatitis.
• To highlight the role of imaging and interventions in patient outcomes.

Main Methods:

• Review of current literature on acute pancreatitis etiology, diagnosis, and treatment.
• Emphasis on the diagnostic value of CT scans versus traditional prognostic markers.
• Evaluation of medical, endoscopic, percutaneous, and surgical treatment modalities.

Main Results:

• CT scans effectively identify pancreatic necrosis and infection, surpassing multiparametric and biohumoral assessments for prognosis.
• Supportive care is vital in early stages; antisecretory and antiprotease drugs lack proven efficacy.
• Antibiotics may prevent septic complications, but their role in preventing bacterial translocation requires further study.
• Endoscopic treatment is beneficial for biliary pancreatitis; percutaneous drainage addresses septic complications; surgery is reserved for infected necrosis or extensive sterile necrosis with organ failure.

Conclusions:

• Biliary factors are significant causes of acute pancreatitis.
• CT imaging is paramount for prognostication.
• Multimodal treatment strategies, including endoscopic and surgical interventions, are essential for managing severe acute pancreatitis and its complications.