Skip to main content
SpringerLink
Log in

Treatment of Mild Acute Pancreatitis and Prevention of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis

  • Chapter
Pancreatitis and Its Complications

Part of the book series: Clinical Gastroenterology ((CG))

  • 1083 Accesses

Abstract

The treatment of mild acute pancreatitis (AP) is largely supportive and includes the administration of fluids intravenously, pain medications, antiemetics, and bowel rest until nausea and vomiting have resolved and narcotics are not required for pain control. Several medications have been studied with the goal to improve patient outcomes, avoid complications associated with pancreatitis, and reduce the time needed for recovery. However, to date, there is no medication proven to alter the course of the disease. This data, as well as the limited data available for the initiation of analgesics and feeding, are reviewed in this chapter. Additionally, the literature on prophylaxis of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis is reviewed.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Baillargeon, JD, Orav J, Vinodhini R, et al. Hemoconcentration as an early risk factor for necrotizing pancreatitis. Am J Gastroenterol 1998; 93: 2130–2134.

    Article  PubMed  CAS  Google Scholar 

  2. Thompson DR. Narcotic analgesic effects on the sphincter of Oddi: A review of the data and therapeutic implications in treating pancreatitis. Am J Gastroenterol 2001; 96: 1266–1272.

    Article  PubMed  CAS  Google Scholar 

  3. Rykowski JJ, Hilgier M. Continuous celiac plexus block in acute pancreatitis. Reg Anesth 1995; 20: 528–532.

    PubMed  CAS  Google Scholar 

  4. Archer SB, Burnett RJ, Fischer JE. Current uses and abuses of total parental nutrition. Adv Surg 1996; 29: 165–189.

    PubMed  CAS  Google Scholar 

  5. Sax HC, Warner BW, Talamini MA, et al. Early total parenteral nutrition in acute pancreatitis: Lack of beneficial effects. Am J Surg 1987; 153: 117–122.

    Article  PubMed  CAS  Google Scholar 

  6. Windsor ACJ, Kanwar S, Li AGK, et al. Compared with parenteral nutrition, enteral feeding attenuates the acute phase response and improves disease severity in acute pancreatitis. Gut 1998; 42: 431–435.

    Article  PubMed  CAS  Google Scholar 

  7. Erstad BL. Enteral nutrition support in acute pancreatitis. Ann Pharmacother 2000; 34: 514–521.

    Article  PubMed  CAS  Google Scholar 

  8. Sarr MG, Sanfey H, Cameron JL. Prospective randomized trial of nasogastric suction in patients with acute pancreatitis. Surgery 1986; 100: 500–54.

    PubMed  CAS  Google Scholar 

  9. Navarro S, Ros E, Aused R, et al. Comparison of fasting, nasogastric suction and cimetidine in the treatment of acute pancreatitis. Digestion 1984; 30: 224–230.

    Article  PubMed  CAS  Google Scholar 

  10. Fuller RK, Loveland JP, Frankel MH. An evaluation of the efficacy of nasogastric suction treatment in alcoholic pancreatitis. Am J Gastroenterol 1981; 75: 349–353.

    PubMed  CAS  Google Scholar 

  11. Meshkinpour H, Molinari MD, Gardner L, et al. Cimetidine in the treatment of acute alcoholic pancreatitis: A randomized double-blind study. Gastroenterology 1979; 77: 687–690.

    PubMed  CAS  Google Scholar 

  12. Maisto OE, Bremner CG. Antacids in the treatment of acute alcohol-induced pancreatitis. SA Med J 1983; 63: 351–352.

    CAS  Google Scholar 

  13. Choi TK, Mok F, Zhan WH, et al. Somatostatin in the treatment of acute pancreatitis: A prospective randomized controlled trial. Gut 1989; 30: 223–227.

    Article  PubMed  CAS  Google Scholar 

  14. Karakoyunlar O, Sivrel E, Tanir N, Denecil AG. High dose octreotide in the management of acute pancreatitis. Hepatogastroenterology 1999; 46: 1968–1972.

    PubMed  CAS  Google Scholar 

  15. Buchler UW, Malfertheiner P, Beger HG, et al. A randomized, double-blind, multicenter trial of octreotide in moderate to severe acute pancreatitis. Gut 1999; 45: 97–104.

    PubMed  Google Scholar 

  16. Lerch MM, Gorelick FS. Early trypsinogen activation in acute pancreatitis. Med Clin N Am 2000; 84: 549–561.

    Article  PubMed  CAS  Google Scholar 

  17. Yang CY, Chang-Chien CS, Liaw YF. Controlled trial of protease inhibitor gabexate mesilate in the treatment of acute pancreatitis. Pancreas 1987; 6: 698–700.

    Article  Google Scholar 

  18. Harada H, Miyake H, Ochi K, Tanaka J, Kimura I. Clinical trial with a protease inhibitor gabexate mesilate in acute pancreatitis. Int J Pancreatol 1991; 9: 75–79.

    PubMed  CAS  Google Scholar 

  19. Valderrama R, Perez-Mateo M, Navarro S, et al. Multicenter double-blind trial of gabexate mesilate in unselected patients with acute pancreatitis. Digestion 1992; 51: 65–70.

    PubMed  CAS  Google Scholar 

  20. Messori A, Rampazzo R, Scroccaro G, et al. Effectiveness of gabexate mesilate in acute pancreatitis: A meta-analysis. Dig Dis Sci 1995; 40: 734–748.

    Article  PubMed  CAS  Google Scholar 

  21. Buchler M, Malfertheiner P, Uhl W, et al. Gabexate mesilate in human acute pancreatitis. German Pancreatitis Study Group. Gastroenterology 1993; 104: 1216–1219.

    Google Scholar 

  22. Platell C, Cooper D, Hall JC. A meta-analysis of peritoneal lavage for acute pancreatitis. J Gastroenterol Hepatol 2001; 16: 689–693.

    Article  PubMed  CAS  Google Scholar 

  23. Montero-Otero R, Rodriguez S, Carbo J, et al. Double blind Trial of Pirenzepine in Acute Pancreatitis. Digestion 1989; 42: 51–56.

    Google Scholar 

  24. Goebell H, Ammann R, Herfarth CH, et al. A double-blind trial of synthetic salmon calcitonin in the treatment of acute pancreatitis. Scand J Gastroent 1979; 14: 881–889.

    Article  PubMed  CAS  Google Scholar 

  25. Freeman ML, James AD, Nelson DB, et al: Risk Factors for post-ERCP pancreatitis: a prospective multicenter study. Gastrointest Endos 2001; 54: 425–434.

    Article  CAS  Google Scholar 

  26. Shimizu Y, Takahashi H, Deura M, et al. Prophylactic effects of preoperative administration of gabexate mesilate on post-ERCP pancreatitis. Gendai Iryo 1979; 11: 540–544.

    Google Scholar 

  27. Salamon V, Kuntz HD, May B, eds. Wirkung Des Suntehetischen Proteinase-Inhibitors FOY Workshop, 1981. Wolf G and Sohn, Dusseldorf, Germany; 1982: 132–135.

    Google Scholar 

  28. Cavallini G, Tittobello A, Frulloni L, et al. Gabexate for the prevention of pancreatic damage related to endoscopic retrograde cholangiopancreatography. Gabexate in digestive endoscopy-Italian Group. N Engl J Med 1996; 335; 961–963.

    Article  Google Scholar 

  29. Andriuilli A, Leandro G. Niro A, et. al. Gastrointest Endosc 2000; 51: 1–7.

    Article  Google Scholar 

  30. Andruilli A, Clemente R, Solmi L, et. al. Gastrointest Endosc, 2002; 56: 488–495.

    Article  Google Scholar 

  31. De Plama GD, Catanzano C. Use of corticosteroids in the prevention of post-ERCP pancreatitis: results of a controlled prospective study. Am J Gastroenterol 1999; 94: 982–985.

    Article  Google Scholar 

  32. Budzynska A, Markek T, Nowak A, et al. A prospective, randomized, placebo-controlled trial of prednisone and allopurinol in the prevention of ERCP-induced pancreatitis. Endoscopy 2001; 33: 766–772.

    Article  PubMed  CAS  Google Scholar 

  33. Borsch G, Bergbauer M, Nebel W, Sbin G. Effect of somatostatin on amylase level and pancreatitis rate following ERCP. Med Welt 1984; 35: 109–112.

    PubMed  CAS  Google Scholar 

  34. Saari A, Kivilaakso E, Schroder T. The influence of somatostatin on pancreatic irritation after pancreatography: an experimental and clinical study. Surg Res Commun 1988; 2: 271–278.

    Google Scholar 

  35. Person B, Slezak P. Efendic S, Haggmark A. Can somatostatin prevent injection pancreatitis after ERCP? Hepatogastroenterology 1992; 39: 259–261.

    Google Scholar 

  36. Tung-Ping Poon R, Yeng C, Lo CM, et al. Prophylactic effect of somatostatin on post-ERCP pancreatitis: a randomized controlled trial. Gastrointest Endosc 1999; 49: 593–598.

    Article  Google Scholar 

  37. Bordas JM, Toledo-Pimentel V, Llach J. Effects of bolus somatostatin in preventing pancreatitis after endoscopic pancreatography: results of a randomized study. Gastrointest Endosc 1998; 47: 230–234.

    Article  PubMed  CAS  Google Scholar 

  38. Bordas JM, Toledo V, Nondelo F, Rodes J. Prevention of pancreatic reactions by bolus somatostatin administration in patients undergoing endoscopic retrograde cholangio-pancreatography and endoscopic sphincterotomy. Horm Res 1988; 29: 106–108.

    PubMed  CAS  Google Scholar 

  39. Binmoeller KF, Harris AG, Dumas R, et al. Does the somatostatin analogue octreotide protect against ERCP-induced pancreatitis? Gut 1992; 33: 1129–1133.

    Article  PubMed  CAS  Google Scholar 

  40. Arvanitidis D, Hatzipanayiotis J, Koutsounopoulos G, Frangou E. The effect of octreotide on the prevention of acute pancreatitis and hyperamylasemia after diagnostic and therapeutic ERCP. Hepatogastro 1998; 19: 248–252.

    Google Scholar 

  41. Testoni PA, Bagnolo F, Andriulli A, Bernasconi G, et al. Octreotide 24-h prophylaxis at high risk for post-ERCP pancreatitis: results of a multicenter, randomized, controlled trial. Aliment Pharmacol Ther 2001; 15: 965–972.

    Article  PubMed  CAS  Google Scholar 

  42. Manolakopoulos S, Avgerinos A, Vlacholgiannakos J, et al. Octreotide versus hydrocortisone versus placebo in the prevention of post-ERCP pancreatitis: a multi-center randomized controlled trial. Gastrointest Endosc 2002; 55: 470–475.

    Article  PubMed  Google Scholar 

  43. Staritz M, Poralla T, Dormeyer HH, Meyer zum Buschenfelde KH. Effect of glyceryl trinitrate on the sphincter of Oddi motility and baseline pressure. Gut 1985; 26: 194–197.

    Article  PubMed  CAS  Google Scholar 

  44. Sudhindran S, Bromwich E, Edwards PR. Prospective randomized double-blind placebo-controlled trial of glyceryl trinitrate in endoscopic retrograde cholangiopancreatography-induced pancreatitis. Br J Surg 2001; 88: 1178–1182.

    Article  PubMed  CAS  Google Scholar 

  45. Moreto M, Zaballa M. Prospective randomized double-blind placebo-controlled trial of glyceryl trinitrate in endoscopic retrograde cholangiopancreatography-induced pancreatitis. Br J Surg 2002; 89: 628–629.

    PubMed  CAS  Google Scholar 

  46. Gabryelewicz A, Kosidlo S, Prokopowicz J, Peokopowicz K. Does heparin modify protease-antiprotease balance in acute experimental pancreatitis in rats? Hepatogastro 1986; 33: 79–92.

    CAS  Google Scholar 

  47. Dobosz M, Hac S, Minonskowska L, et al. Microcirculatory disturbances of the pancreas in caerulein-induced acute pancreatitis in rats with reference to L-arginine, heparin, and procaine treatment. Pharmacol Res 1997; 36: 123–128.

    Article  PubMed  CAS  Google Scholar 

  48. Rabenstein T, Sylvia R, Framke B, et al. Complications of endoscopic sphincterotomy: Can heparin prevent acute pancreatitis after ERCP? Gastrointest Endosc 2002; 55: 476–483.

    Article  PubMed  Google Scholar 

  49. Deviere J, Le Moine O, Van Laethem JL, et al. Interleukin 10 reduces the incidence of pancreatitis after therapeutic endoscopic retrograde cholangiopancreatography. Gastroenterology 2001; 120: 498–505.

    Article  PubMed  CAS  Google Scholar 

  50. Dumot JA, Conwell DL, Zuccaro G, et al. A randomized, double-blind study of interleukin 10 for the prevention of ERCP-induced pancreatitis. Am J Gastroenterol 2001; 96: 2098–2102.

    Article  PubMed  CAS  Google Scholar 

  51. Murray B, Carter R, Imrie C, et al. Diclofenac reduces the incidence of acute pancreatitis after endoscopic retrograde cholangiopancreatography. Gastroenterology 2003; 124: 1786–1791.

    Article  PubMed  CAS  Google Scholar 

  52. Smithline A, Silverman W, Rogers D, et. al. Effect of prophylactic main pancreatic duct stenting on the incidence of biliary endoscopic sphincterotomy-induced pancreatitis in high risk patients. Gastrointest Endosc 1993; 39: 652–657.

    PubMed  CAS  Google Scholar 

  53. Sherman S, Earl D, Bucksot L, et al. Does leaving a main pancreatic duct stent in place reduce the incidence of pre cut biliary sphincterotomy pancreatitis? Am J Gastroenterol 1995; 90: 1614.

    Google Scholar 

  54. Tarnasky P, Yuko P, Cunningham JT, et al. Pancreatic stenting prevents pancreatitis after biliary sphincterotomy in patients with sphincter of Oddi dysfunction. Gastroenterology 1998; 115: 1518–1524.

    Article  PubMed  CAS  Google Scholar 

  55. Aizawa T, Ueno N. Stent placement in the pancreatic duct prevents pancreatitis after endoscopic sphincter dilation for removal of bile duct stones. Gastrointest Endosc 2001; 54: 209–213.

    PubMed  CAS  Google Scholar 

  56. Fazel A, Quadri A, Catalano M, et al. Does a pancreatic duct stent prevent post ERCP pancreatitis? A prospective randomized study. Gastrointest Endosc 2003; 57: 291–294.

    Article  PubMed  Google Scholar 

  57. Singh P, Sivak M, Agarwal D, et al. Prophylactic pancreatic stenting for prevention of post ERCP pancreatitis: Ameta-analysis of controlled trials. Gastrointest Endosc 2003; 57: AB89.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Digestive Diseases, Department of Medicine, University of Cincinnati, Cincinnati, OH

    Michael Morelli MD & Lehel Somogyi MD

Authors
  1. Michael Morelli MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lehel Somogyi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Division of Gastroenterology, Hepatology, and Nutrition, University of Florida College of Medicine, Gainesville, Fl

    Chris E. Forsmark MD

Rights and permissions

Reprints and permissions

Copyright information

© 2005 Humana Press Inc., Totowa, NJ

About this chapter

Cite this chapter

Morelli, M., Somogyi, L. (2005). Treatment of Mild Acute Pancreatitis and Prevention of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis. In: Forsmark, C.E. (eds) Pancreatitis and Its Complications. Clinical Gastroenterology. Humana Press. https://doi.org/10.1385/1-59259-815-3:063

Download citation

  • DOI: https://doi.org/10.1385/1-59259-815-3:063

  • Publisher Name: Humana Press

  • Print ISBN: 978-1-58829-179-0

  • Online ISBN: 978-1-59259-815-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation