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Lessons Learnt in Management of Acute Pancreatitis

Objective Acute Pancreatitis continues to be a confounding clinical problem and can pose a formidable challenge in its management. This invited review discusses the various clinical studies done while managing cases of acute pancreatitis and the possible avenues for further studies. Method Clinical studies done on various aspects of pancreatitis viz. severity prediction using bedside index of severity in acute pancreatitis score and its validation in Indian patients, current status of interventions in pancreatitis, timing of enteral nutrition in acute pancreatitis, vasospasm in early phase of acute pancreatitis and ductal involvement in acute pancreatitis were reviewed. Results of each study are discussed briefly. The shortcomings of each study were analysed. A review of current literature pertaining to each of these aspects was carried out. Results In all, 5 clinical studies were reviewed. Validation of bedside index of severity in acute pancreatitis score, study of interventions in acute pancreatitis and timing of enteral feeding in acute pancreatitis were prospective observational studies. The results of the bedside index of severity in acute pancreatitis score validation and interventions in acute pancreatitis correlate well with the current literature. Existing literature on various modalities for intervention is discussed. There are not many studies addressing the issue of timing of institution of nasojejunal feeds. Study of vasospasm and ductal involvement in acute pancreatitis were both retrospective. Fluid management in early acute pancreatitis and ductal involvement with disconnected pancreatic duct syndrome are being studied extensively across many centres. Conclusion Clinical studies which address various issues in pancreatitis are building blocks for better understanding of the disease evolution. These lessons learnt also form the basis for further research.

Author(s): Deshpande Aparna, Velhal Rishikesh, Thanky Harsh, Soman Sundeep, Shah Ritesh

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