Journal of the Pancreas Open Access

Analysis of the Literature on the Treatment of Refractory Pancreatic Fistula

Tim J. Tilo^* Department of Internal Medicine I, Gastroenterology, Hepatology & Endocrinology, Medical University Innsbruck, Innsbruck, Austria
^*Correspondence: Tim J. Tilo, Department of Internal Medicine I, Gastroenterology, Hepatology & Endocrinology, Medical University Innsbruck, Austria, Email:

Received: 07-Sep-2022, Manuscript No. IPP-22-15210; Editor assigned: 09-Sep-2022, Pre QC No. IPP-22-15210(PQ); Reviewed: 23-Sep-2022, QC No. IPP-22-15210; Revised: 30-Sep-2022, Manuscript No. IPP-22-15210(R); Published: 03-Oct-2022, DOI: 10.35841/1590-8577-23.10.768

INTRODUCTION

Predictive scoring systems, hydration management and nutrition, as well as follow-up and risk-reduction efforts for acute pancreatitis are all currently recommended. Several scoring systems, such as the Bedside Index of Severity in Acute Pancreatitis (BISAP) and the Acute Physiology and Chronic Health Evaluation (APACHE) II tools, have good predictive capabilities for disease severity (mild, moderately severe, and severe per the revised Atlanta classification) and mortality, but no single tool is effective for all types of acute pancreatitis. Early and aggressive fluid resuscitation, as well as early enteral feeding, have been linked to lower rates of mortality and infectious complications, however the best type and pace of fluid resuscitation are yet unknown [1].

In all patients with acute pancreatitis, the underlying cause should be determined, and risk-reduction therapies such as cholecystectomy and alcohol cessation counseling should be implemented both during and after hospitalization [1].

Acute pancreatitis is caused by hypertriglyceridemia, which is the third most prevalent cause. It is most common in people who have an underlying lipoprotein metabolism disease and a secondary condition such as uncontrolled diabetes, alcohol misuse, or medication usage. Hypertriglyceridemia-induced pancreatitis presents similarly to acute pancreatitis caused by other factors; however, patients with hypertriglyceridemiainduced pancreatitis are more likely to have severe disease courses and are more likely to have permanent organ failure. Hypertriglyceridemia-induced pancreatitis is treated similarly to acute pancreatitis caused by other factors, with intensive fluid resuscitation, pain management, and nutritional support. When necessary, hypertriglyceridemia is treated with apheresis or insulin treatment. The early detection of hypertriglyceridemia in acute pancreatitis is critical for both the initial and long-term therapy of the condition, as well as the prevention of recurrent acute pancreatitis. The goal of this study is to emphasize the aetiology, pathophysiology, and clinical course of acute pancreatitis caused by hypertriglyceridemia [2].

This review focuses on recent advancements in the diagnosis and treatment of acute pancreatitis (AP). The epidemiological, clinical, and management aspects of AP are the focus of our research. We also talk about how risk stratification technologies can help with clinical decision-making. Only a small percentage of patients experience moderately severe AP, which is defined as a pancreatic local problem, or severe AP, which is characterized as persistent organ failure. In mild cases of AP, treatment usually consists of a diagnostic examination and supportive care, with a short hospital stay. A comprehensive approach is required in severe AP to reduce morbidity and death throughout the course of a long hospital stay [3].

Guidelines On Severe Acute Pancreatitis

The Italian Association for the Study of the Pancreas (AISP) has published clinically focused guidelines for the diagnosis and treatment of severe acute pancreatitis. Three working groups of experts drafted the statements after searching and analyzing the most recent literature; a modified Delphi technique was then used to reach a consensus. The statements offer advice on how to define the consequences of severe acute pancreatitis, how to diagnose the condition, and when to use conservative and interventional endoscopic, radiological, and surgical treatments [4].

In recent years, there has been a significant amount of material published on the therapy of acute severe acute pancreatitis. Data on updated single or multi-parameter severity assessment methods and categorization systems, as well as therapy modalities, are among the new data. However, a few basic concerns, such as the best severity assessment modality, the amount of IV fluids necessary in the first 48 to 72 hours, and the function of prophylactic antibiotics, remain unclear and controversial. The Revised Atlanta Classification was developed by the International Working Group and will be published soon. This new classification is eagerly expected around the world, and it is hoped that it will resolve many of the issues raised by the original Atlanta Classification [5].

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