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Pancreatitis

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Multiple organ failure might be an indication for prophylactic antifungal therapy in acute pancreatitis.
Ning C, Zhu S, Zhou S, Lin C, Li J, Cao X, Bonsu A, Shen D, Liu Z, Huang G.
Infection. 2021 Aug;49(4):769-774.

Rationale for inclusion: Large retrospective study that provides indications for antifungal therapy in acute pancreatitis.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

Improved mortality in necrotizing pancreatitis with a multidsciplinary minimally invasive step-up approach: Comparison with a modern open necrosectomy cohort.
Luckhurst C, El Hechi M, Elsharkawy A, Eid A, Maurer L, Kaafarani H, Thabet A, Forcione D, Castillo C, Lillemoe K, Fagenholz.
J Am Coll Surg. 2020 Jun;230(6):873-883.

Rationale for inclusion: This is a recent observational cohort study that compares MIS-based minimally invasive approach vs an open necrosectomy and showed a 5-fold decrease in mortality.

 

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Superiority of Step-up Approach vs Open Necrosectomy in Long-term Follow-up of Patients With Necrotizing Pancreatitis.
Hollemans RA, Bakker OJ, Boermeester MA, Bollen TL, Bosscha K, Bruno MJ, Buskens E, Dejong CH, van Duijvendijk P, van Eijck CH, Fockens P, van Goor H, van Grevenstein WM, van der Harst E, Heisterkamp J, Hesselink EJ, Hofker S, Houdijk AP, Karsten T, Kruyt PM, van Laarhoven CJ, Laméris JS, van Leeuwen MS, Manusama ER, Molenaar IQ, Nieuwenhuijs VB, van Ramshorst B, Roos D, Rosman C, Schaapherder AF, van der Schelling GP, Timmer R, Verdonk RC, de Wit RJ, Gooszen HG, Besselink MG, van Santvoort HC; Dutch Pancreatitis Study Group.
Gastroenterology. 2019 Mar;156(4):1016-1026.

Rationale for inclusion: This represents long term follow up of patients in the origical PANTER trial published in 2018. The results originially identified in that trial of decreased mortality and major morbidity appear to be both consistent and durable at long term follow up.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

Enhanced Recovery in Mild Acute Pancreatitis: A Randomized Controlled Trial.
Dong E, Chang JI, Verma D, Butler RK, Villarin CK, Kwok KK, Chen W, Wu BU.
Pancreas. 2019 Feb;48(2):176-181.

Rationale for inclusion: This double-blind, randomized controlled trial compared the use of a protocolized enhanced recovery bundle on time to oral feeding and pancreatitis activity score. There was no difference in length of stay or readmission.

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Meta-Analysis of Early Enteral Nutrition Provided Within 24 Hours of Admission on Clinical Outcomes in Acute Pancreatitis.
Qi D, Yu B, Huang J, Peng M.
JPEN J Parenter Enteral Nutr. 2018 Sep;42(7):1139-1147.

Rationale for inclusion: In this metaanalysis, 8 studies were analyzed and early entereal nutrition initiated within 24 hours. This study identified no benfits in the mild or moderate pancreatitis groups. However in the predicted severe or severe groups (APACHE score of at least 6) there was a lower rate of mortality and multiple organ failure.

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Endoscopic retrograde cholangiopancreatography decreases all-cause and pancreatitis readmissions in patients with acute gallstone pancreatitis who do not undergo cholecystectomy: a nationwide 5-year analysis
Qayed E, Shah R, Haddad YK.
Pancreas. 2018 Apr;47(4):425-435.

Rationale for Inclusion: Although cholecystectomty is performed as definitive managmenet of gallstone pancreatitis this study utilizing the 2010-2014 National Readmissions database of more than 150,000 admissions for gallstone pancreaitis demonstrated that ERCP was associated with reduced readmissions and support performing ERCP in patients unfit for surgery.

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American Gastroenterological Association Institute Guideline on Initial Management of Acute Pancreatitis
Crockett SD, Wani S, Gardner TB, Falck-Ytter Y, Barkun AN.
Gastroenterology. 2018 Mar;154(4):1096-1101.

Rationale for inclusion: Using GRADE methodology, this paper makes recommendations for the diagnosis and management of pancreatitis.

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Endoscopic or surgical step-up approach for infected necrotising pancreatitis: a multicentre randomised trial
van Brunschot S, van Grinsven J, van Santvoort HC, Bakker OJ, Besselink MG, Boermeester MA, Bollen TL, Bosscha K, Bouwense SA, Bruno MJ, Cappendijk VC, Consten EC, Dejong CH, van Eijck CH, Erkelens WG, van Goor H, van Grevenstein WMU, Haveman JW, Hofker SH, Jansen JM, Laméris JS, van Lienden KP, Meijssen MA, Mulder CJ, Nieuwenhuijs VB, Poley JW, Quispel R, de Ridder RJ, Römkens TE, Scheepers JJ, Schepers NJ, Schwartz MP, Seerden T, Spanier BWM, Straathof JWA, Strijker M, Timmer R, Venneman NG, Vleggaar FP, Voermans RP, Witteman BJ, Gooszen HG, Dijkgraaf MG, Fockens P.
Lancet. 2018 Jan 6;391(10115):51-58.

Rationale for Inclusion: This randomized controlled trial comparing the endoscopic step-up approach to the surgical step-up approach demonstrated that the endoscopic approach is not superior in reducing major complications or death.

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Implementation of an acute care surgery service facilitates modern clinical practice guidelines for gallstone pancreatitis.
Murphy PB, Paskar D, Parry NG, Racz J, Vogt KN, Symonette C, Leslie K, Mele TS.
J Am Coll Surg. 2015 Nov;221(5):975-81.

Rationale for inclusion: This paper uniquely supports the creation of an ACS team in the treatment of gallstone pancreatitis and further supports the practice of cholecystectomy during index admission for gallstone pancreatitis.

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Same-admission versus interval cholecystectomy for mild gallstone pancreatitis (PONCHO): a multicentre randomised controlled trial.
da Costa DW, Bouwense SA, Schepers NJ, Besselink MG, van Santvoort HC, van Brunschot S, Bakker OJ, Bollen TL, Dejong CH, van Goor H, Boermeester MA, Bruno MJ, van Eijck CH, Timmer R, Weusten BL, Consten EC, Brink MA, Spanier BW, Bilgen EJ, Nieuwenhuijs VB, Hofker HS, Rosman C, Voorburg AM, Bosscha K, van Duijvendijk P, Gerritsen JJ, Heisterkamp J, de Hingh IH, Witteman BJ, Kruyt PM, Scheepers JJ, Molenaar IQ, Schaapherder AF, Manusama ER, van der Waaij LA, van Unen J, Dijkgraaf MG, van Ramshorst B, Gooszen HG, Boerma D; Dutch Pancreatitis Study Group.
Lancet. 2015 Sep 26;386(10000):1261-8.

Rationale for inclusion: This represents a multi-center RCT in patients with mild biliary pancreatitis and further supports index admission cholecystectomy in patients with mild disease (utilizing defined criteria).

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Surgical management of chronic pancreatitis: current utilization in the United States.
Bliss LA, Yang CJ, Eskander MF, de Geus SW, Callery MP, Kent TS, Moser AJ, Freedman SD, Tseng JF.
HPB (Oxford). 2015 Sep;17(9):804-10.

Rationale for inclusion: Although rare, surgical intervention in chronic pancreatitis may be useful in complex cases. In a study of more than 21 000 patients, the authors attempt to identify outcomes in patients who undergo surgery. The findings suggest that surgical management is a viable management strategy that can be associated with improved long-term outcomes. Earlier surgical intervention may also reduce the need for prolonged opioid pain management.

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Role of Antibiotic Prophylaxis in Necrotizing Pancreatitis: A Meta-Analysis.
Lim CL, Lee W, Liew YX, Tang SS, Chlebicki MP, Kwa AL.
J Gastrointest Surg. 2015 Mar;19(3):480-91.

Rationale for inclusion: In a meta-analysis of 11 studies including 864 patients, the use of prophylactic antibiotics was not shown to significantly reduce the incidence of infected pancreatic necrosis but appeared to affect all-cause mortality in acute necrotizing pancreatitis.

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Early oral refeeding based on hunger in moderate and severe acute pancreatitis: A prospective controlled, randomized clinical trial.
Zhao XL, Zhu SF, Xue GJ, Li J, Liu YL, Wan MH, Huang W, Xia Q, Tang WF.
Nutrition. 2015 Jan;31(1):171-5.

Rationale for inclusion: Enteral nutrition in acute pancreatitis is well established. The timing however remains unclear. This prospective randomized study helps establish timing in the disease process.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

Gallstone pancreatitis without cholecystectomy.
Hwang SS, Li BH, Haigh P.
Hwang SS, Li BH, Haigh P.

Rationale for inclusion: This is a large cohort study over a 15 year period with excellent long-term follow-up.  It demonstrates that in patients presenting with acute gallstone pancreatitis who undergo ERCP with or without sphincterotomy but did NOT receive a subsequent cholecystectomy, the overall risk for recurrence at 1, 2, and 5 years were roughly 5%, 7.5%, and 10%.  The rates are roughly double for those patients who did not receive ERCP during the index hospitalization.  This study provides strong supporting evidence for ERCP and cholecystectomy to prevent recurrence of biliary pancreatitis. 

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

American College of Gastroenterology guideline: management of acute pancreatitis.
Tenner S, Baillie J, DeWitt J, Vege SS; American College of Gastroenterology.
Am J Gastroenterol. 2013 Sep;108(9):1400-15; 1416.

Rationale for inclusion: Utilizing GRADE methodology, this paper makes recommendations for the diagnosis and management of pancreatitis that may not be covered in the other recommended papers.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

Clear liquid diet vs soft diet as the initial meal in patients with mild acute pancreatitis: a randomized interventional trial.
Rajkumar N, Karthikeyan VS, Ali SM, Sistla SC, Kate V.
Nutr Clin Pract. 2013 Jun;28(3):365-70.

Rationale for inclusion: This study is intriguing as it evaluates patients with mild acute pancreatitis and randomizes them to soft versus clear liquid diets with the finding of significantly shorter lengths of stay in those that receive the soft diet as the initial po option.

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Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus.
Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, Tsiotos GG, Vege SS; Acute Pancreatitis Classification Working Group.
Gut. 2013 Jan;62(1):102-11.

Rationale for inclusion: This work represents a global consensus statement and updates the 1992 Atlanta Classification with better classifications of the disease, local complications, and systemic complications.

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A step-up approach or open necrosectomy for necrotizing pancreatitis.
van Santvoort HC, Besselink MG, Bakker OJ, Hofker HS, Boermeester MA, Dejong CH, van Goor H, Schaapherder AF, van Eijck CH, Bollen TL, van Ramshorst B, Nieuwenhuijs VB, Timmer R, Laméris JS, Kruyt PM, Manusama ER, van der Harst E, van der Schelling GP, Karsten T, Hesselink EJ, van Laarhoven CJ, Rosman C, Bosscha K, de Wit RJ, Houdijk AP, van Leeuwen MS, Buskens E, Gooszen HG; Dutch Pancreatitis Study Group.
N Engl J Med. 2010 Apr 22;362(16):1491-502.

Rationale for inclusion: This RCT evaluates the step-up approach compared to open necrosectomy and shows favorable outcomes for patients that are able to be managed with percutaneous and minimally invasive therapies.

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Enteral nutrition and the risk of mortality and infectious complications in patients with severe acute pancreatitis: a meta-analysis of randomized trials.
Petrov MS, van Santvoort HC, Besselink MG, van der Heijden GJ, Windsor JA, Gooszen HG.
Arch Surg. 2008 Nov;143(11):1111-7.

Rationale for inclusion: This meta-analysis of RCTs looks specifically at patients with predicted severe acute pancreatitis and clearly shows improved outcomes in those receiving enteral versus parenteral nutrition.

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Meta-analysis of enteral nutrition versus total parenteral nutrition in patients with severe acute pancreatitis.
Cao Y, Xu Y, Lu T, Gao F, Mo Z.
Ann Nutr Metab. 2008;53(3-4):268-75.

Rationale for inclusion: This study represents a meta-analysis of RCTs and further supports enteral nutrition over parenteral nutrition for severe acute pancreatitis.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

Timing of surgical intervention in necrotizing pancreatitis.
Besselink MG, Verwer TJ, Schoenmaeckers EJ, Buskens E, Ridwan BU, Visser MR, Nieuwenhuijs VB, Gooszen HG.
Arch Surg. 2007 Dec;142(12):1194-201.

Rationale for inclusion: This work includes a retrospective review and a systematic review and is yet another work supporting a delayed approach to necrosectomy.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

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