Akute Pankreatitis – Update zu Diagnose, Management und Nachsorge

Die akute Pankreatitis ist eine der häufigsten nicht krebsassoziierten Krankenhausdiagnosen in der Gastroenterologie. Die Einschätzung des Schweregrades und die adäquate Therapie komplizierter Verläufe bleiben klinisch herausfordernd und erfordern ein interdisziplinäres Vorgehen. In diesem Artikel werden aktuelle und praxisrelevante Empfehlungen diskutiert und anhand von Fällen aus dem Klinikum der LMU in München illustriert.

Schlüsselwörter

akute Pankreatitis - walled-off pancreatic necrosis - Schweregradabschätzung - Volumentherapie - Nachsorge

• Literatur

• 1 Banks PA, Bollen TL, Dervenis C. et al. Classification of acute pancreatitis – 2012: revision of the Atlanta classification and definitions by international consensus. Gut 2013; 62: 102-111
• 2 Dellinger EP, Forsmark CE, Layer P. et al. Determinant-based classification of acute pancreatitis severity: an international multidisciplinary consultation. Ann Surg 2012; 256: 875-880
• 3 Beyer G, Hoffmeister A, Michl P. et al. S3-Leitlinie Pankreatitis. Leitlinie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS). AWMF Registernummer 021-003. September 2021. Im Internet (Stand: 31.12.2021): http://www.awmf.org/leitlinien/detail/ll/021-003.html
• 4 Wu BU, Johannes RS, Sun X. et al. The early prediction of mortality in acute pancreatitis: a large population-based study. Gut 2008; 57: 1698-1703
• 5 Lankisch PG, Weber-Dany B, Hebel K. et al. The harmless acute pancreatitis score: a clinical algorithm for rapid initial stratification of nonsevere disease. Clin Gastroenterol Hepatol 2009; 7: 702-705 quiz 607
• 6 Mounzer R, Langmead CJ, Wu BU. et al. Comparison of existing clinical scoring systems to predict persistent organ failure in patients with acute pancreatitis. Gastroenterology 2012; 142: 1476-1482 quiz e1415–1476
• 7 Ding N, Sun YH, Wen LM. et al. Assessment of prophylactic antibiotics administration for acute pancreatitis: a meta-analysis of randomized controlled trials. Chin Med J (Engl) 2020; 133: 212-220
• 8 Phillip V, Huber W, Hagemes F. et al. Incidence of acute pancreatitis does not increase during Oktoberfest, but is higher than previously described in Germany. Clin Gastroenterol Hepatol 2011; 9: 995-1000.e1003
• 9 Schepers NJ, Hallensleben NDL, Besselink MG. et al. Urgent endoscopic retrograde cholangiopancreatography with sphincterotomy versus conservative treatment in predicted severe acute gallstone pancreatitis (APEC): a multicentre randomised controlled trial. Lancet 2020; 396: 167-176
• 10 da Costa DW, Bouwense SA, Schepers NJ. et al. Same-admission versus interval cholecystectomy for mild gallstone pancreatitis (PONCHO): a multicentre randomised controlled trial. Lancet 2015; 386: 1261-1268
• 11 Pedersen SB, Langsted A, Nordestgaard BG. Nonfasting mild-to-moderate hypertriglyceridemia and risk of acute pancreatitis. JAMA Intern Med 2016; 176: 1834-1842
• 12 Kiss L, Für G, Mátrai P. et al. The effect of serum triglyceride concentration on the outcome of acute pancreatitis: systematic review and meta-analysis. Sci Rep 2018; 8: 14096
• 13 Gubensek J, Buturovic-Ponikvar J, Romozi K. et al. Factors affecting outcome in acute hypertriglyceridemic pancreatitis treated with plasma exchange: an observational cohort study. PLoS One 2014; 9: e102748
• 14 Werge M, Novovic S, Schmidt PN. et al. Infection increases mortality in necrotizing pancreatitis: A systematic review and meta-analysis. Pancreatology 2016; 16: 698-707
• 15 Boxhoorn L, van Dijk SM, van Grinsven J. et al. Immediate versus postponed intervention for infected necrotizing pancreatitis. N Engl J Med 2021; 385: 1372-1381
• 16 van Santvoort HC, Besselink MG, Bakker OJ. et al. A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med 2010; 362: 1491-1502
• 17 van Brunschot S, van Grinsven J, van Santvoort HC. et al. Endoscopic or surgical step-up approach for infected necrotising pancreatitis: a multicentre randomised trial. Lancet 2018; 391: 51-58
• 18 Bang JY, Arnoletti JP, Holt BA. et al. An endoscopic transluminal approach, compared with minimally invasive surgery, reduces complications and costs for patients with necrotizing pancreatitis. Gastroenterology 2019; 156: 1027-1040.e1023
• 19 Bang JY, Navaneethan U, Hasan MK. et al. Non-superiority of lumen-apposing metal stents over plastic stents for drainage of walled-off necrosis in a randomised trial. Gut 2019; 68: 1200-1209
• 20 Stecher SS, Simon P, Friesecke S. et al. Delayed severe bleeding complications after treatment of pancreatic fluid collections with lumen-apposing metal stents. Gut 2017; 66: 1871-1872
• 21 Kirkpatrick AW, Sugrue M, McKee JL. et al. Update from the Abdominal Compartment Society (WSACS) on intra-abdominal hypertension and abdominal compartment syndrome: past, present, and future beyond Banff 2017. Anaesthesiol Intensive Ther 2017; 49: 83-87
• 22 Nikkola J, Laukkarinen J, Huhtala H. et al. The intensity of brief interventions in patients with acute alcoholic pancreatitis should be increased, especially in young patients with heavy alcohol consumption. Alcohol Alcohol 2017; 52: 453-459