Controversies in the management of acute pancreatitis: An update

Abstract

This review summarized the current controversies in the management of acute pancreatitis (AP). The controversies in management range from issues involving fluid resuscitation, nutrition, the role of antibiotics and antifungals, which analgesic to use, role of anticoagulation and intervention for complications in AP. The interventions vary from percutaneous drainage, endoscopy or surgery. Active research and emerging data are helping to formulate better guidelines. The available evidence favors crystalloids, although the choice and type of fluid resuscitation is an area of dynamic research. The nutrition aspect does not have controversy as of now as early enteral feeding is preferred most often than not. The empirical use of antibiotics and antifungals are gray zones, and more data is needed for conclusive guidelines. The choice of analgesic is being studied, and the recommendations are still evolving. The position of using anticoagulation is still awaiting consensus. The role of intervention is well established, although the modality is constantly changing and favoring endoscopy or percutaneous drainage rather than surgery. It is evident that more multicenter randomized controlled trials are required for establishing the standard of care in these crucial management issues of AP to improve the morbidity and mortality worldwide.

Keywords: Acute pancreatitis; Fluid resuscitation; Antibiotics; Analgesia; Anti coagulation; Intervention

Core Tip: The controversies in the management of acute pancreatitis are an area of dynamic research, and emerging data is assisting in guideline formulation. The current evidence favors crystalloids, although the choice and type of fluid resuscitation is an evolving research area. The empirical use of antibiotics and antifungals are gray zones and lack guidelines. The choice of analgesic lacks definite recommendations. The role of anticoagulation lacks agreement. The role of intervention is well established and favors endoscopy or percutaneous drainage rather than surgery. It is obvious that more evidence is essential for effective guidelines in these critical management issues of acute pancreatitis.