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  • Review Article
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Treatment options for acute pancreatitis

Nature Reviews Gastroenterology & Hepatology volume 11, pages 462–469 (2014)Cite this article

Subjects

Key Points

  • The 2012 Revised Atlanta Classification and the determinant-based classifications for acute pancreatitis aim to define the different local and systemic complications of this disease and predict interventions and outcomes

  • These different classifications can be viewed as complementary; some of the terminology might need further development to provide more exact definitions

  • Several prophylactic strategies have been tested to prevent complications in acute pancreatitis, but no strategy has proved to be successful

  • Progress has been made in the management of infected pancreatic necrosis with the use of a step-up approach and minimally invasive techniques

Abstract

This Review covers the latest developments in the treatment of acute pancreatitis. The Atlanta Classification of acute pancreatitis has been revised, proposing several new terms and abandoning some of the old and confusing terminology. The 2012 Revised Atlanta Classification and the determinant-based classification aim to universally define the different local and systemic complications and predict outcome. The most important differences between these classifications are discussed. Several promising treatment options for the early management of acute pancreatitis have been tested, including the use of enteral nutrition and antibiotics as well as novel therapies such as haemofiltration and protease inhibitors. The results are summarized and the quality of evidence is discussed. Finally, new developments in the management of patients with infected pancreatic necrosis are addressed, including the use of the 'step-up approach' and results of minimally invasive necrosectomy.

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Figure 1: A patient with acute pancreatitis.

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Acknowledgements

We acknowledge the work of the Dutch Pancreatitis Study Group.

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Authors and Affiliations

  1. Department of Surgery, Room G04.228, University Medical Center Utrecht, Heidelberglaan 100, PO Box 85500, Utrecht, 3508 GA, Netherlands

    Olaf J. Bakker & Hjalmar C. van Santvoort

  2. Department of Surgery (Suite G4-136), Academic Medical Center, Meibergdreef 9, 1105 AZ, PO Box 22660, Amsterdam, 1100 DD, Netherlands

    Yama Issa, Marc G. Besselink & Marja A. Boermeester

  3. Department of Gastroenterology & Hepatology, Erasmus Medical Center, University Medical Center Rotterdam, 's-Gravendijkwal 230, Rotterdam, 3015 CE, Netherlands

    Nicolien J. Schepers & Marco J. Bruno

  4. Department of Operation Rooms/Evidence Based Surgery, Radboud University Medical Centre, Geert Grooteplein zuid 10, PO Box 9101, Nijmegen, 6500 HB, Netherlands

    Hein G. Gooszen

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  1. Olaf J. Bakker
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Contributions

All authors contributed to researching data for the article and discussing content. O.J.B. wrote the article. Y. I., H.C.v.S., M.G.B., N.J.S., M.J.B., M.A.B. and H.G.G. contributed to reviewing/editing the manuscript before submission.

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Correspondence to Hein G. Gooszen.

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Bakker, O., Issa, Y., van Santvoort, H. et al. Treatment options for acute pancreatitis. Nat Rev Gastroenterol Hepatol 11, 462–469 (2014). https://doi.org/10.1038/nrgastro.2014.39

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