Treatment of Pancreatic Diseases

  • Milan KujundžićEmail author
  • Željko Čabrijan
  • Tomislav Bokun
Part of the Clinical Gastroenterology book series (CG)


Treatment of acute pancreatitis should be started as early as possible because fluid resuscitation in the first 24 h is of the utmost importance. Pain should be alleviated and early changes to nutrition considered. Antibiotics should not be introduced unless signs of systemic inflammatory response syndrome with suspicion of infection, concomitant biliary infection, or another organ infection are present. Various local complications can occur, which may be treated conservatively, minimally invasively, or surgically. Early endoscopic biliary decompression should be considered in patients with biliary pancreatitis. For chronic pancreatitis, lifestyle modifications should be encouraged, and pain relief medications should be gradually introduced. Patients with obstructive forms of chronic pancreatitis might benefit from endoscopic treatment, whereas surgical treatment should be considered for patients with disabling pain that cannot be controlled by medical treatment and is refractory to endoscopic treatment. Pancreatic exocrine insufficiency is often difficult to define and should be treated with pancreatic enzyme replacement therapy. Pancreatic cancer has a poor prognosis, and its management depends on the disease stage. Generally, in cases of resectable illness, surgery should be considered, with postoperative chemotherapy. Locally advanced disease (unresectable) can be treated with chemo(radio)therapy or stereotactic body radiotherapy; the best supportive care should be offered to patients with poor performance status. Systemic chemotherapy should be considered for patients with metastatic disease, and supportive care and palliative treatment should be provided.


Acute pancreatitis Walled-off necrosis Infected necrosis Pancreatic pseudocyst Chronic pancreatitis Pancreatic exocrine insufficiency Pancreatic exocrine replacement therapy Pancreatic cancer 


  1. 1.
    Yokoe M, Takada T, Mayumi T, Yoshida M, Isaji S, Wada K, et al. Japanese guidelines for the management of acute pancreatitis: Japanese guidelines 2015. J Hepatobiliary Pancreat Sci. 2015;22(6):405–32.CrossRefPubMedGoogle Scholar
  2. 2.
    Tenner S, Baillie J, DeWitt J, Vege SS. American College of Gastroenterology. American College of Gastroenterology guideline: management of acute pancreatitis. Am J Gastroenterol. 2013;108(9):1400–15.CrossRefPubMedGoogle Scholar
  3. 3.
    Greenberg JA, Hsu J, Bawazeer M, Marshall J, Friedrich JO, Nathens A, et al. Clinical practice guideline: management of acute pancreatitis. Can J Surg. 2016;59(2):128–40.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology. 2013;13(4 Suppl 2):e1–15.Google Scholar
  5. 5.
    Forsmark CE, Swaroop Vege S, Wilcox CM. Acute pancreatitis. Campion EW, editor. N Engl J Med. 2016;375(20):1972–81.CrossRefPubMedGoogle Scholar
  6. 6.
    Ukai T, Shikata S, Inoue M, Noguchi Y, Igarashi H, Isaji S, et al. Early prophylactic antibiotics administration for acute necrotizing pancreatitis: a meta-analysis of randomized controlled trials. J Hepatobiliary Pancreat Sci. 2015;22(4):316–21.CrossRefPubMedGoogle Scholar
  7. 7.
    Löhr JM, Dominguez-Munoz E, Rosendahl J, Besselink M, Mayerle J, Lerch MM, et al. United European gastroenterology evidence-based guidelines for the diagnosis and therapy of chronic pancreatitis (HaPanEU). United Eur Gastroenterol J. 2017;5(2):153–99.CrossRefGoogle Scholar
  8. 8.
    Singh VK, Drewes AM. Medical management of pain in chronic pancreatitis. Dig Dis Sci. 2017;62(7):1721–8.CrossRefPubMedGoogle Scholar
  9. 9.
    Majumder S, Chari ST. Chronic pancreatitis. Lancet. 2016;387(10031):1957–66.CrossRefPubMedGoogle Scholar
  10. 10.
    Dumonceau J-M, Delhaye M, Tringali A, Dominguez-Munoz J, Poley J-W, Arvanitaki M, et al. Endoscopic treatment of chronic pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline. Endoscopy. 2012;44(8):784–800.CrossRefPubMedGoogle Scholar
  11. 11.
    Dumonceau J-M, Tringali A, Blero D, Devière J, Laugiers R, Heresbach D, et al. Biliary stenting: indications, choice of stents and results: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline. Endoscopy. 2012;44(3):277–98.CrossRefPubMedGoogle Scholar
  12. 12.
    Andersen DK, Andren-Sandberg Å, Duell EJ, Goggins M, Korc M, Petersen GM, et al. Pancreatitis–diabetes–pancreatic cancer. Pancreas. 2013;42(8):1227–37.CrossRefPubMedGoogle Scholar
  13. 13.
    Navaneethan U, Njei B, Lourdusamy V, Konjeti R, Vargo JJ, Parsi MA. Comparative effectiveness of biliary brush cytology and intraductal biopsy for detection of malignant biliary strictures: a systematic review and meta-analysis. Gastrointest Endosc. 2015;81(1):168–76.CrossRefPubMedGoogle Scholar
  14. 14.
    Hu B, Sun B, Cai Q, Wong Lau JY, Ma S, Itoi T, et al. Asia-Pacific consensus guidelines for endoscopic management of benign biliary strictures. Gastrointest Endosc. 2017;86(1):44–58.CrossRefPubMedGoogle Scholar
  15. 15.
    Smith RC, Smith SF, Wilson J, Pearce C, Wray N, Vo R, et al. Summary and recommendations from the Australasian guidelines for the management of pancreatic exocrine insufficiency. Pancreatology. 2016;16(2):164–80.CrossRefPubMedGoogle Scholar
  16. 16.
    Khorana AA, Mangu PB, Berlin J, Engebretson A, Hong TS, Maitra A, et al. Potentially curable pancreatic cancer: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol. 2016;34(21):2541–56.CrossRefPubMedGoogle Scholar
  17. 17.
    Ducreux M, Cuhna AS, Caramella C, Hollebecque A, Burtin P, Goéré D, et al. Cancer of the pancreas: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2015;26(Suppl 5):v56–68.CrossRefPubMedGoogle Scholar
  18. 18.
    National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Pancreatic Adenocarcinoma, V2. NCCN. 2016.
  19. 19.
    Balaban EP, Mangu PB, Khorana AA, Shah MA, Mukherjee S, Crane CH, et al. Locally advanced, Unresectable pancreatic cancer: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol. 2016;34(22):2654–68.CrossRefPubMedGoogle Scholar
  20. 20.
    Sohal DPS, Mangu PB, Khorana AA, Shah MA, Philip PA, O’Reilly EM, et al. Metastatic pancreatic cancer: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol. 2016;34(23):2784–96.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Milan Kujundžić
    • 1
    • 2
    Email author
  • Željko Čabrijan
    • 1
    • 2
  • Tomislav Bokun
    • 1
    • 2
  1. 1.Department of Gastroenterology, Hepatology and Clinical NutritionUniversity Hospital DubravaZagrebCroatia
  2. 2.University of Zagreb School of MedicineZagrebCroatia

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