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Review
. 2023 May 14;29(18):2747-2763.
doi: 10.3748/wjg.v29.i18.2747.

Current trends in acute pancreatitis: Diagnostic and therapeutic challenges

Enver Zerem  1 , Admir Kurtcehajic  2 , Suad Kunosić  3 , Dina Zerem Malkočević  4 , Omar Zerem  4
Affiliations
Review

Current trends in acute pancreatitis: Diagnostic and therapeutic challenges

Enver Zerem et al. World J Gastroenterol. .

Abstract

Acute pancreatitis (AP) is an inflammatory disease of the pancreas, which can progress to severe AP, with a high risk of death. It is one of the most complicated and clinically challenging of all disorders affecting the abdomen. The main causes of AP are gallstone migration and alcohol abuse. Other causes are uncommon, controversial and insufficiently explained. The disease is primarily characterized by inappropriate activation of trypsinogen, infiltration of inflammatory cells, and destruction of secretory cells. According to the revised Atlanta classification, severity of the disease is categorized into three levels: Mild, moderately severe and severe, depending upon organ failure and local as well as systemic complications. Various methods have been used for predicting the severity of AP and its outcome, such as clinical evaluation, imaging evaluation and testing of various biochemical markers. However, AP is a very complex disease and despite the fact that there are of several clinical, biochemical and imaging criteria for assessment of severity of AP, it is not an easy task to predict its subsequent course. Therefore, there are existing controversies regarding diagnostic and therapeutic modalities, their effectiveness and complications in the treatment of AP. The main reason being the fact, that the pathophysiologic mechanisms of AP have not been fully elucidated and need to be studied further. In this editorial article, we discuss the efficacy of the existing diagnostic and therapeutic modalities, complications and treatment failure in the management of AP.

Keywords: Antibiotics; Diagnostic criteria; Etiology and pathogenesis; Management of complications; Nutrition; Pancreatitis.

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Conflict of interest statement

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Figures

Figure 1
Figure 1
The revised Atlanta Classification: Key terms diagram. APFC: Acute pancreatic fluid collection; PPC: Pancreatic pseudo cyst; ANC: Acute necrotic collection; WON: Walled-off necrosis.
Figure 2
Figure 2
Treatment of pancreatic walled-off necrosis and two fistulas by percutaneous drainage. A: Appearance of iodine via cutaneous fistula after its instillation into the walled-off necrosis (WON); B: Retropancreatic WON with two fistulas. Fistula 1: Retropancreatic-percutaneous fistula; Fistula 2: Retropancreatic-sigmoidal fistula. WON: Walled-off necrosis.
Figure 3
Figure 3
Ultrasound appearance of pancreatic walled-off necrosis after acute necrotizing pancreatitis. WON: Walled-off necrosis.
See this image and copyright information in PMC

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