Modern trends in diagnosis and treatment of acute pancreatitis (based on the 56th meeting of the European Pancreatic Club, Santiago de Compostela, Spain, June 26–29, 2024)

Abstract

The article provides an overview of selected reports on acute pancreatitis presented at EPC 2024. Genetic factors receive significant attention in the progression of acute pancreatitis to chronic pancreatitis. Mutations in the genes regulating trypsinogen and chymotrypsinogen play a special role. It makes sense to use trypsinogen inhibitors in the prevention of exacerbation of recurrent and chronic pancreatitis rather than in the treatment of acute pancreatitis in patients with a proven genetic problem in trypsinogen suppression. Patients with infected necrosis should primarily use an endoscopic step-up approach when treating localized pancreatic necrosis. Transgastric drainage, nasogastric catheter installation, extended crystalloid administration, and local antibiotic administration improve the results. Necrosectomy is most effective when performed concurrently with the placement of a self-expanding stent, as this procedure has demonstrated a reduction in re-interventions and hospital stays. Only patients with infected necrosis should undergo surgery. Gas in the necrotic cavity on CT provides a 94% probability of identifying infected necrosis. A step-up approach allows avoiding unnecessary surgical trauma in critically ill patients, while up to 30% of fluid collections resolve over time without intervention. The incidence of major complications in soft pancreas surgery is 6–24%, pancreatic fistula — 10–40%, postoperative bleeding — 3–8%, and stool retention — 20–34%. A randomized controlled trial found that using hydrocortisone during surgery and in the early days afterward could lower the risk of acute postoperative pancreatitis, which is the main cause of major complications. The determination of trypsinogen-2 in urine is one of the most effective markers. Acute postoperative pancreatitis is a common problem. There is no pathogenetic treatment for acute postoperative pancreatitis. Unfortunately, in most cases, treatment begins a few days after resection of the pancreas, which is the trigger for this problem. We should apply the principles of “therapy without haste” to these patients. For the prevention and treatment of acute postoperative pancreatitis, we should implement strategies such as late initiation of enteral nutrition, targeted infusion therapy, use of proton pump inhibitors, monitoring of amylase in the blood and drains (leaving the drains for a longer period), early CT scanning (on the 3^rd day after surgery), and use of steroids (hydrocortisone). This article may be of interest to surgeons with a special focus on the treatment of acute pancreatitis, as well as to a wide range of physicians.