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Permanent URL to this publication: http://dx.doi.org/10.5167/uzh-18544

Heinrich, S; Schäfer, M; Rousson, V; Clavien, P A (2006). Evidence-based treatment of acute pancreatitis: a look at established paradigms. Annals of Surgery, 243(2):154-168.

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Abstract

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.

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Epidemology, Biostatistics and Prevention Institute (EBPI)
DDC:610 Medicine & health
Language:English
Date:2006
Deposited On:15 May 2009 13:31
Last Modified:27 Nov 2013 21:30
Publisher:Lippincott Wiliams & Wilkins
ISSN:0003-4932
Publisher DOI:10.1097/01.sla.0000197334.58374.70
PubMed ID:16432347
Citations:Web of Science®. Times Cited: 153
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Scopus®. Citation Count: 205

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