GI Surgery – Biliary Tract and Pancreas
ACG Guideline: Management of Acute Pancreatitis
20 Mar, 2024 | 21:49h | UTCThis guideline, crafted by the American College of Gastroenterology, provides essential strategies for managing acute pancreatitis, offering a concise overview of diagnosis, treatment, and prevention recommendations for healthcare professionals. Here is a summary of the key information contained in the document:
- Introduction and Epidemiology: Acute pancreatitis (AP) is one of the most common gastrointestinal diseases leading to hospitalization in the United States, with about 300,000 admissions annually and a cost of over 2.5 billion dollars. The incidence of AP has been increasing annually, although the mortality rate has remained stable due to advancements in management.
- Etiology and Diagnosis: AP is typically caused by gallstones and alcohol consumption. Diagnosis is made based on the presence of two of the following three criteria: characteristic abdominal pain, serum amylase and/or lipase levels more than three times the upper limit of normal, and/or characteristic findings on abdominal imaging.
- Initial Management and Hydration: Initial management emphasizes the importance of moderate to aggressive intravenous hydration, preferably with lactated Ringer’s solution over normal saline, due to its potential benefit in reducing systemic inflammation and preventing complications.
- Nutrition: Patients with mild AP are encouraged to start early oral feeding within 24 to 48 hours as tolerated, preferring a low-fat solid diet over a progressive approach from liquids to solids.
- Management of Complications: The document addresses the management of complications such as pancreatic necrosis, suggesting the use of antibiotics only in cases of infected necrosis and highlighting a preference for minimally invasive methods of debridement and necrosectomy.
- Prevention of Recurrence and Role of ERCP: To prevent recurrences in biliary pancreatitis, cholecystectomy is recommended. In selected cases of acute biliary pancreatitis without cholangitis, medical therapy is preferred over early ERCP.
- Use of Antibiotics: The guidelines discourage the prophylactic use of antibiotics in cases of severe AP without evidence of infection, due to the lack of demonstrated benefit and potential risks.
Tenner, S. et al (2024). American College of Gastroenterology Guidelines: Management of Acute Pancreatitis. The American Journal of Gastroenterology, 119(3), 419-437. https://doi.org/10.14309/ajg.0000000000002645
Proposed algorithm for appropriate fluid management in acute pancreatitis
8 Aug, 2023 | 13:33h | UTCFluid treatment in acute pancreatitis: a careful balancing act – British Journal of Surgery
Related:
Update on the management of acute pancreatitis – Current Opinion in Critical Care
Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis – New England Journal of Medicine
Acute Pancreatitis: Diagnosis and Treatment – Drugs
Evidence-Based Disposition of Acute Pancreatitis – emDocs
Pancreatitis – National Institute for Health and Care Excellence
Research: Endoscopic or Surgical Step-up Approach for Infected Necrotising Pancreatitis
Evidence-Based Approach to the Surgical Management of Acute Pancreatitis – The Surgery Journal
RCT | Exploring the impact of total pancreatectomy with islet autotransplantation to reduce postoperative complications
8 Aug, 2023 | 13:25h | UTC
Determination of “borderline resectable” pancreatic cancer – A global assessment of 30 shades of grey
8 Aug, 2023 | 13:22h | UTC
Commentary on Twitter
What is BORDERLINE respectable?! ?
A global assessment of 30 shades of grey ???
? Interobserver variability among radiologists and surgeons globally is high
?⚖️ Central review of images required for quality control initiativeshttps://t.co/Z2G1cInZ5f pic.twitter.com/mlucwMT5f9
— Giovanni Marchegiani (@Gio_Marchegiani) July 30, 2023
Consensus Paper | Minimally invasive pancreatic surgery
8 Aug, 2023 | 13:20h | UTC
Review | Contemporary artery-first approaches in pancreatoduodenectomy
27 Jun, 2023 | 13:43h | UTCContemporary artery-first approaches in pancreatoduodenectomy – British Journal of Surgery
Cohort Study | Dengue patients at high risk of cholecystitis and pancreatitis within 30 days
21 Jun, 2023 | 13:34h | UTC
Review | Serial serum lipase testing after the initial diagnostic workup for inpatients with acute pancreatitis: what is the evidence?
21 Jun, 2023 | 13:27h | UTC
Cohort Study | UK pancreatitis study reveals gallstones as most common cause
29 May, 2023 | 10:57h | UTC
Commentary on Twitter
Panc Collaborative?(113?, 2580?) on acute pancreatitis shows 50% related to gall?, 20% idiopathic and 5% severe. ✝️2.3% overall, but >30% in severe cases! Age, ♂️& frailty predicted ⚰️:https://t.co/dw9tR5Uyjg#SoMe4Surgery @BJSAcademy @BJSurgery @young_bjs #some4hpb #SurgEd pic.twitter.com/AAPf8L4lnt
— BJS Open (@BjsOpen) May 12, 2023
Review | Hereditary colorectal, gastric, and pancreatic cancer
18 May, 2023 | 13:43h | UTCHereditary colorectal, gastric, and pancreatic cancer: comprehensive review – BJS Open
Commentary on Twitter
Have a?at our latest comprehensive review covering all u need to know?about hereditary ?colorectal, gastric & pancreatic?! https://t.co/y1LL0DNRiy@Adductor @DrRABurkhart #SoMe4Surgery #StepUp4CRC #SurgEd #MedTwitter @BJSAcademy @BJSurgery @juliomayol @young_bjs Great read! pic.twitter.com/JmmOmMBydO
— BJS Open (@BjsOpen) May 11, 2023
Fluorescence-guided surgery: comprehensive review
18 May, 2023 | 13:34h | UTCFluorescence-guided surgery: comprehensive review – BJS Open
Commentary on Twitter
Find all you ever wanted to know about the current state of fluorescence-guided surgery ???in our latest comprehensive review by @BJSurgery editor @paulo_sutt et al. Absolutely worth reading!https://t.co/Tgrj4UvOzV@BJSAcademy @juliomayol @young_bjs #SoMe4Surgery #MedTwitter pic.twitter.com/ReArdO1LOs
— BJS Open (@BjsOpen) May 17, 2023
Current perioperative care in pancreatoduodenectomy: a step-by-step surgical roadmap from first visit to discharge
16 May, 2023 | 14:52h | UTC
Commentary on Twitter
Step by step surgical roadmap ?️ for pancreatoduodenectomy
? Pre, intra and post operative periods have specific landmarks
⚖️ Such factors weight the actual value of surgery vs. alternative options
? is minimize complications and patients selectionhttps://t.co/3obsQdfHs6 pic.twitter.com/6EHoRjc2wE
— Giovanni Marchegiani (@Gio_Marchegiani) April 27, 2023
RCT | Interrupted vs. continuous suture technique for biliary-enteric anastomosis
16 May, 2023 | 14:22h | UTC
Commentary on Twitter
Interrupted vs continuous suture for bilioenteric anastomosis?#RCT ???=82
⏱️Cont. suture approx 10mins quicker
⚖️No difference in biliary complications#some4hpb #SoMe4Surgery https://t.co/7Vo7GlBG9V pic.twitter.com/mdRM7xWkIS— BJS Open (@BjsOpen) February 6, 2023
Review | Predicting postoperative pancreatic fistula and pancreatitis after pancreatoduodenectomy or distal pancreatectomy
10 May, 2023 | 15:41h | UTC
Commentary from the author on Twitter
All you ever wanted to know about prediction of pancreatic fistula or postoperative pancreatitis – See new review paper w @BonsdorffA in @ScandJSurg !https://t.co/i73czVzXtu pic.twitter.com/tleWlAJsr3
— Ville Sallinen (@villesallinen) April 21, 2023
EASL-ILCA Clinical practice guidelines on the management of intrahepatic cholangiocarcinoma
9 May, 2023 | 14:47h | UTC
Commentary on Twitter
?#CPG in press❕
EASL-ILCA Clinical Practice Guidelines on the management of #IntrahepaticCholangiocarcinoma
?Find it here?https://t.co/buM8rgBU1F@EASLedu@EASLnews#iCCA#LiverTwitter pic.twitter.com/raR983x0qk
— Journal of Hepatology (@JHepatology) April 20, 2023
Guideline | Perioperative management of patients undergoing endoscopic retrograde cholangiopancreatography
4 May, 2023 | 13:52h | UTC
Consensus definition of sludge and microlithiasis as a possible cause of pancreatitis
3 May, 2023 | 15:22h | UTCConsensus definition of sludge and microlithiasis as a possible cause of pancreatitis – Gut
Review | Multidisciplinary management in the treatment of intrahepatic cholangiocarcinoma
28 Apr, 2023 | 13:03h | UTC
SR | Etiology, diagnosis, and modern management of chronic pancreatitis
24 Apr, 2023 | 13:29h | UTCEtiology, Diagnosis, and Modern Management of Chronic Pancreatitis: A Systematic Review – JAMA Surgery (free for a limited period)
RCT | Piperacillin-tazobactam better than cefoxitin in antimicrobial prophylaxis for open pancreatoduodenectomy
21 Apr, 2023 | 13:08h | UTCPiperacillin-Tazobactam Compared With Cefoxitin as Antimicrobial Prophylaxis for Pancreatoduodenectomy: A Randomized Clinical Trial – JAMA (free for a limited period)
Editorial: Informing a Rational Approach to Antimicrobial Prophylaxis in Open Pancreatoduodenectomy – JAMA (free for a limited period)
Commentary on Twitter
Study findings support the use of piperacillin-tazobactam as perioperative antimicrobial prophylaxis for open pancreatoduodenectomy. https://t.co/M9qAVrePRH pic.twitter.com/xq01qPTHQO
— JAMA (@JAMA_current) April 20, 2023
Review | Diagnostic, structured classification and therapeutic approach in cystic pancreatic lesions
12 Apr, 2023 | 12:58h | UTCRelated:
Cystic pancreatic lesions: MR imaging findings and management.
Recommendations for the management of incidental pancreatic findings in adults.
Pancreatic cystic neoplasms: a review of current recommendations for surveillance and management
Management of Pancreatic Cystic Lesions
Consensus Recommendations: Diagnosis and Surveillance of Incidental Pancreatic Cystic Lesions
Review: Pancreatic Cystic Lesions
Guidelines on pancreatic cystic neoplasms
SR | Risk factors for cholangitis after pancreatoduodenectomy
11 Apr, 2023 | 14:21h | UTC
Preliminary study suggests a PEG-coated hemostatic patch reduces pancreatic fistula post-pancreatoduodenectomy
11 Apr, 2023 | 14:02h | UTC
Commentary on Twitter
POPF prevention ? any help from haemostatic patches?!
? Polyethylene glycol-coated haemostatic patch for prevention: RCT from ??
? POPF reduction 90% (!!!) regardless of other risk factors
? What is your practice?! https://t.co/Fn7OgFgwTR pic.twitter.com/ZjlxuUTZEN
— Giovanni Marchegiani (@Gio_Marchegiani) April 7, 2023
Cohort Study | Impact of complications after resection of pancreatic cancer on disease recurrence and survival
10 Apr, 2023 | 13:34h | UTC
Commentary on Twitter
Major complications after?surgery are known to impair DF- and OS ➡️?of all ?? pat undergoing panc surgery 2014–2017 (n=1071) confirms via causal mediation ?that this is mediated due to omission of adjuvant CTX!https://t.co/8kjr9MpRt4#some4surgery #some4hpb @BJSAcademy pic.twitter.com/EZd7Yvi4z2
— BJS Open (@BjsOpen) April 1, 2023
Brief Review | What every gastroenterologist should know about gastrointestinal neuroendocrine tumors
4 Apr, 2023 | 13:29h | UTC