Endoscopic management of acute pancreatitis

Consensus guidelines on severe acute pancreatitis

This Position Paper contains clinically oriented guidelines by the Italian Association for the Study of the Pancreas (AISP) for the diagnosis and treatment of severe acute pancreatitis. The statements were formulated by three working groups of experts who searched and analysed the most recent literature; a consensus process was then performed using a modified Delphi procedure. The statements provide recommendations on the most appropriate definition of the complications of severe acute pancreatitis, the diagnostic approach and the timing of conservative as well as interventional endoscopic, radiological and surgical treatments.

Diagnostic value of different endoscopic sphincterotomy procedures in idiopathic pancreatitis combined with juxtapapillary duodenal diverticulum

AIM: To evaluate the diagnostic value of different endoscopic sphincterotomy procedures in patients with idiopathic pancreatitis combined with juxtapapillary duodenal diverticulum.

METHODS: A retrospective study of 18 patients who were diagnosed with idiopathic pancreatitis combined with juxtapapillary duodenal diverticula and treated at our hospital over the past seven years was performed. The postoperative complications and recurrence rate were compared between patients undergoing two different sphincterotomy procedures.

RESULTS: Of the 18 patients, 17 underwent endoscopic retrograde cholangiopancreatography (ERCP), and the success rate was 94.44%. All these 17 patients received endoscopic sphincterotomy, of whom 8 received small incision and balloon dilatation and 9 received middle incision; 14 received endoscopic nasal bile duct drainage and 3 received bile duct stenting. In the middle incision group, 2 cases had intraoperative minor bleeding and 1 case developed postoperative gastrointestinal bleeding. No major complications such as massive perforation were observed in the two groups.

CONCLUSION: The small incision and balloon dilatation method may be more safe and effective in patients with idiopathic pancreatitis combined with juxtapapillary duodenal diverticulum, and it can also help clarify the etiology and achieve effective control and prevention of recurrence.