Clinical Pancreatology: For Practising Gastroenterologists and Surgeons

733 Pages·2021·24.708 MB·English

by  Juan Enrique Dominguez-Munoz

Clinical Pancreatology for Practising Gastroenterologists
and Surgeons
Clinical Pancreatology for Practising Gastroenterologists
and Surgeons
Second Edition
Edited by
J. Enrique Domínguez-Muñoz MD, PhD
Director, Department of Gastroenterology and Hepatology
University Hospital of Santiago de Compostela
Santiago de Compostela, Spain
This edition first published 2021
© 2021 John Wiley & Sons Ltd
Edition History
Blackwell Publishing Ltd (1e, 2005)
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Library of Congress Cataloging-in-Publication Data
Names: Domínguez-Muñoz , J. Enrique, editor.
Title: Clinical pancreatology for practising gastroenterologists and
surgeons / edited by
J. Enrique Domínguez-Muñoz.
Description: Second edition. | Hoboken, NJ : Wiley-Blackwell, 2021. |
Includes bibliographical references and index.
Identifiers: LCCN 2020025990 (print) | LCCN 2020025991 (ebook) | ISBN
9781119570073 (cloth) | ISBN 9781119570080 (adobe pdf) | ISBN
9781119570141 (epub)
Subjects: MESH: Pancreatitis–diagnosis | Pancreatitis–therapy |
Gastroenterology–methods
Classification: LCC RC858.P35 (print) | LCC RC858.P35 (ebook) | NLM WI
805 | DDC 616.3/7–dc23
LC record available at https://lccn.loc.gov/2020025990
LC ebook record available at https://lccn.loc.gov/2020025991
Cover Design: Wiley
Cover Images: J. Enrique Domínguez-Muñoz
Set in 9.5/12.5pt STIXTwoText by SPi Global, Pondicherry, India
10 9 8 7 6 5 4 3 2 1
v
Contents
Contributors xxxiii
Foreword xlvi
Preface xlvii
Dedication xlviii
Section I Acute Pancreatitis 1
1 Acute Pancreatitis: An Overview 3
Jodie A. Barkin and Jamie S. Barkin
­Introduction­ 3
­Causes­ 3
­Laboratory­Diagnosis­ 6
­Imaging­ 6
­Risk­Stratification­ 7
­Classification­ 7
­Treatment­ 8
Prophylactic­Antibiotics­ 8
Nutrition­ 9
Post-discharge­Cholecystectomy­ 9
­Long-term­Sequelae­ 11
­References­ 12
2 How to Deal with the Etiological Diagnosis of Acute Pancreatitis in Clinical Practice? 17
Soumya Jagannath and Pramod Kumar Garg
­Introduction­ 17
­Etiological­Diagnosis­ 17
Gallstone-induced­Pancreatitis­ 17
Microlithiasis­ 18
Alcoholic­Pancreatitis­ 19
Drug-induced­Pancreatitis­ 19
Other­Etiological­Diagnoses­of Acute­Pancreatitis­ 19
Hypercalcemia­ 19
Hypertriglyceridemia­ 19
Smoking­ 19
Type­2­Diabetes­Mellitus­ 19
Pancreatobiliary­Tumors­ 20
Post-ERCP­Pancreatitis­ 20
Single­and Double­Balloon­Enteroscopy­ 20
Congenital­Anomalies­ 20
Idiopathic­Acute­Pancreatitis­ 21
vi Contents
­Investigative­Work-up­ 21
­Concluding­Remarks­ 22
­References­ 22
3 Definition of Complications and Severity of Acute Pancreatitis for Clinical Practice 25
David X. Jin, Peter A. Banks, and Julia McNabb-Baltar
­Background­ 25
­The­Atlanta­Classification­1992­ 25
­The­Revised­Atlanta­Classification­2012­ 25
Definition­of Organ­Failure­and Complications­in Acute­Pancreatitis­ 25
Organ­Failure­ 25
Local­Complications­ 26
Systemic­Complications­ 27
Definition­of Severity­in Acute­Pancreatitis­ 27
Mild­Acute­Pancreatitis­ 28
Moderately­Severe­Acute­Pancreatitis­ 28
Severe­Acute­Pancreatitis­ 28
Limitations­of the Revised­Atlanta­Classification­ 28
­The­Determinant-Based­Classification­ 28
­Conclusion­ 29
­References­ 29
4 Early Prediction of Severity in Acute Pancreatitis: What can be Done in Clinical Practice? 31
Peter J. Lee and Georgios I. Papachristou
­Introduction­ 31
­Available­Prediction­Tools­ 31
Volume­Deficit­ 31
Inflammatory­Response­ 33
Host-related­Characteristics­ 33
Age­and Comorbidity­Burden­ 33
Obesity­and Hypertriglyceridemia­ 33
Degree­of Parenchymal­and Extra-parenchymal­Injury­ 34
­Scoring­Systems­ 34
­Limitations­and Future­of Current­Scoring­Systems­and Predictive­Markers­ 35
­Artificial­Intelligence­and Biomarkers:­the Future?­ 35
­References­ 36
5 Role of CT Scan in Acute Pancreatitis: When is it Indicated and What
Information can be Obtained? 40
Elham Afghani, Mahya Faghih, and Vikesh K. Singh
­CT­Imaging­in Acute­Pancreatitis­ 40
Confirming­the Diagnosis­of AP­ 40
Assessing­the Etiology­of Acute­Pancreatitis­ 40
Assessing­the Prognosis­of Acute­Pancreatitis­ 41
Identifying­Local­Complications­Associated­with Acute­Pancreatitis­ 41
Pancreatic­Necrosis­and Peripancreatic­Fluid­Collections­ 41
Vascular­Complications­ 42
Other­Complications­ 43
­Timing­of CT­in Acute­Pancreatitis­ 43
­Limitations­of CT­Imaging­ 44
­Conclusion­ 44
­Disclosures­ 44
­References­ 44
Contents vii
6 Role of MRI in Acute Pancreatitis: When is it Indicated and What Information can be Obtained? 47
Fatih Akisik
­Introduction­ 47
­MRI­and MRCP­Protocol­for Pancreas­Examination­ 47
­Interstitial­Edematous­Pancreatitis­ 48
­Necrotizing­Pancreatitis­ 48
­Complications­of Acute­Pancreatitis­ 50
Fluid­Collections­ 50
Acute­Peripancreatic­Fluid­Collection­ 50
Acute­Necrotic­Collection­ 50
Pseudocyst­ 50
Walled-off­Necrosis­ 50
Vascular­Complications­ 50
­References­ 51
7 Treatment of Acute Pancreatitis in The Emergency Room: What Should be Done
During the First Hours of Disease? 53
Thiruvengadam Muniraj and Santhi Swaroop Vege
­Introduction­ 53
­Early­Diagnosis­in the Emergency­Room­ 53
­Initial­Work-up­for Etiology­ 54
­Severity­Assessment,­Triage,­and Disposition­ 54
­Specialty­Consultation­ 54
­Management­ 55
First-line­Medical­Management:­Fluid­Resuscitation­ 55
Type­of Intravenous­Fluid­to Administer­ 55
Antibiotics­ 55
Pain­Control­ 55
Nutrition­ 56
­Summary­ 56
­References­ 56
8 Acute Pancreatitis: A Practical Guideline for the Monitoring and Treatment of Systemic Complications 59
Enrique de Madaria and Felix Zubia-Olaskoaga
­Introduction­ 59
­Acute­Pancreatitis­and Systemic­Complications:­Definitions,­Importance,­and Incidence­ 59
­Monitoring­Respiratory­Function­and Management­of Respiratory­Failure­ 60
­Shock:­Volume­Management­and Hemodynamic­Monitoring­ 60
­Acute­Renal­Failure:­Early­Detection­and Management­ 61
­Other­Systemic­Complications­Associated­with Acute­Pancreatitis­ 62
Hypocalcemia­ 62
Disseminated­Intravascular­Coagulation­ 62
Gastrointestinal­Bleeding­ 62
Pancreatic­Encephalopathy­and Posterior­Reversible­Encephalopathy­Syndrome­ 62
­Abdominal­Compartment­Syndrome­ 63
­References­ 63
9 Guidelines for the Treatment of Pain in Acute Pancreatitis 66
László Czakó
­Introduction­ 66
­Nonsteroidal­Anti-inflammatory­Drugs­ 66
­Opioid­Analgesics­ 67
­Epidural­Analgesia­ 68
viii Contents
­Local­Anesthetics­ 69
­Summary­ 70
­References­ 70
10 Nutrition in the Acute Phase of Pancreatitis: Why, When, How and How Long? 72
Angela Pham and Chris E. Forsmark
­Why­ 72
­When­ 73
­How­ 73
­What­to Feed­ 75
­References­ 75
11 Oral Refeeding in Acute Pancreatitis: When and How Should it be Restarted? 78
José Lariño-Noia and Daniel de la Iglesia-García
­Introduction­ 78
­What­is­the Optimal­Timing­of­Refeeding­in AP?­ 78
­How­Should­Oral­Refeeding­be Scheduled?­ 79
­What­are­the Predictors­of Oral­Feeding­Intolerance­in AP­Patients?­ 79
­Summary­and Recommendations­ 81
­References­ 81
12 Pharmacological Therapy for Acute Pancreatitis: Any Light at the End of the Tunnel? 83
Rajarshi Mukherjee, Muhammad Awais, Wenhao Cai, Wei Huang, Peter Szatmary, and Robert Sutton
­Introduction­ 83
­Calcium­Toxicity­ 84
­Mitochondrial­Dysfunction­ 84
­Autophagy­ 86
­Acinar­Cell­Secretion,­Serine­Proteases,­and Serine­Protein­Kinases­ 86
­Immune­Cells/Inflammation­ 87
­CFTR­ 89
­Design­of Future­Clinical­Trials­ 89
­Conclusion­ 89
­References­ 90
13 Indication and Optimal Timing of ERCP in Acute Pancreatitis 95
Theodor Voiosu, Ivo Boškoski, and Guido Costamagna
­Introduction­ 95
­ERCP­in the Setting­of Acute­Biliary­Pancreatitis­ 95
Urgent­ERCP­ 96
Elective­ERCP­ 96
­Additional­Applications­of ERCP­in­the­Setting­of Acute­Pancreatitis­ 97
­Conclusions­ 98
­Disclosures­ 98
­References­ 98
14 How to Deal with Infected Pancreatic Necrosis? 100
J. Enrique Domínguez-Muñoz
­Introduction­ 100
­Prevention­of Infection­of (Peri)pancreatic­Necrosis­ 100
­Diagnosis­of Infected­(Peri)pancreatic­Necrosis­ 101
­How­to Deal­with Infected­(Peri)pancreatic­Necrosis­ 101
Systemic­Antibiotics­ 101
Endoscopic­or­Percutaneous­Drainage­ 101
Contents ix
Endoscopic­or­Laparoscopic­Necrosectomy­ 102
­References­ 102
15 Minimally Invasive Surgical Necrosectomy in Clinical Practice:
Indications, Technical Issues, and Optimal Timing 105
Patricia Sánchez-Velázquez, Fernando Burdío, and Ignasi Poves†
­Introduction­ 105
­Percutaneous­Drainage­ 105
­Sinus­Tract­Endoscopy­ 106
­Endoscopic­(Endoluminal)­Approach­ 106
­Retroperitoneal­Approach­ 108
­Laparoscopic­Transperitoneal­Approach­ 109
­References­ 111
16 Endoscopic Necrosectomy in Clinical Practice: Indications, Technical Issues and Optimal Timing 113
Jodie A. Barkin and Andres Gelrud
­Introduction­ 113
­Management­of Symptomatic­Pseudocysts­ 114
­Management­of Symptomatic­Walled-off­Necrosis­ 114
Indications­and Timing­for Intervention­ 114
Choosing­the Best­Interventional­Option:­the­Step-up­Approach­ 115
Methods­of Endoscopic­Necrosectomy­and Stent­Choice­ 116
­Conclusion­ 117
­References­ 118
17 Management of Acute Pancreatic Pseudocyst: When to Observe, When and How to Drain? 120
Muhammad F. Dawwas and Kofi W. Oppong
­Introduction­ 120
­Evaluation­ 120
­Drainage­Therapy­ 122
­Disconnected­Pancreatic­Duct­Syndrome­ 124
­Complications­ 124
­Conclusion­ 124
­References­ 125
18 The Disconnected Main Pancreatic Duct Syndrome: How to Proceed in Clinical Practice? 126
Mario Peláez-Luna, Andrea Soriano-Ríos, and Luis Uscanga-Dominguez
­Introduction­ 126
­Epidemiology­ 126
­Risk­Factors­and Predictors­of DPDS­ 126
­Clinical­Significance­ 126
­Clinical­Presentation­ 127
­Diagnosis­ 127
­Treatment­ 128
­Conclusions­ 129
­References­ 130
19 Vasculature Complications in Pancreatitis: How to Deal with Them? 132
Daniel G. McCall and Timothy B. Gardner
­Venous­Complications­ 132
Splanchnic­Thrombosis­Rates­ 132
Risk­Factors­for Thrombosis­ 132
Clinical­Findings­ 133
x Contents
Screening­ 133
Splenic­Vein­Thrombosis­ 133
Portal­Vein­Thrombosis­ 133
Management­of Visceral­Vein­Thrombosis­ 134
Anticoagulation­ 134
Surgical­Management­ 135
Miscellaneous­Venous­Complications­ 135
Bowel­Wall­Ischemia­ 135
Portal­Vein–Pseudocyst­Fistula­ 135
­Arterial­Complications­ 135
Pseudoaneurysm­ 135
Pseudoaneurysm­and Risk­of Rupture­ 136
Hemosuccus­Pancreaticus­ 137
Imaging­of Pseudoaneurysm­or­Potential­Hemorrhage­ 137
Ruptured­Pseudoaneurysm­Management­ 138
­Summary­ 138
­References­ 138
20 Acute Relapsing Pancreatitis: What can be Done to Prevent Relapses? 141
Jorge D. Machicado and Dhiraj Yadav
­Introduction­ 141
­Definition­ 141
­Burden­ 141
­Demographics­ 142
­Etiology­ 142
­Diagnostic­Work-up­ 143
­Natural­History­and Risk­of Progression­ 144
­Preventing­Recurrences­and Disease­Progression­ 146
­Conclusion­ 147
Acknowledgment­ 147
­References­ 147
21 Diagnosis and Therapeutic Approach to Pancreatic Exocrine Insufficiency after Acute Pancreatitis 151
Hester C. Timmerhuis, Christa J. Sperna Weiland, and Hjalmar C. van Santvoort
­Introduction­ 151
­Symptoms­ 151
­Diagnosis­ 152
­Management­ 152
­Summary­ 154
­References­ 155
22 Asymptomatic Chronic Elevation of Serum Pancreatic Enzymes: How to Deal with It? 158
Giuseppe Vanella, Paolo Giorgio Arcidiacono, and Gabriele Capurso
­Introduction­ 158
­Physiology­of Pancreatic­Enzymes­ 158
­Pancreatic­Abnormalities­in Patients­with Pancreatic­Hyperenzymemia­ 158
Pancreatic­Hyperenzymemia:­A Clue­to Malignancy?­ 160
Pancreatic­Abnormalities­at­Second-level­Imaging­ 160
­Gastrointestinal­Diseases­and Pancreatic­Hyperenzymemia­ 160
Inflammatory­Bowel­Disease­ 160
Celiac­Disease­ 160
Liver­Disease­ 161
Others­ 161
Contents xi
­Macroenzymemia­ 161
­Systemic­Conditions­Associated­with Hyperenzymemia­ 161
Familial­Aggregation­and Genetics­ 161
­Drug-induced­Hyperenzymemia­ 161
­Extrapancreatic­Abnormalities­in Patients­with Hyperenzymemia­ 162
Salivary­Gland­Diseases­ 162
Renal­Insufficiency­ 162
Hyperenzymemia­and Cancers­ 162
Eating­Disorders­ 162
Others­ 162
­Benign­Pancreatic­Hyperenzymemia­(Gullo­Syndrome)­ 163
Clinical­Features­ 163
Physiopathology­ 163
­Algorithm­for­Management­of­CAPH­(Figure 22.2)­ 163
Clinical­History­and Laboratory­Evaluation­ 163
Isolated­Hyperamylasemia­ 164
Pancreatic­Hyperamylasemia­and/or­Hyperlipasemia­ 165
­Conclusions­ 165
­References­ 165
Section II Chronic Pancreatitis 169
23 Definition and Etiology of Chronic Pancreatitis: What is Relevant for Clinical Practice? 171
David C. Whitcomb
­Definition­of Key­Terms­and Concepts­ 171
Dysfunction­ 171
Disorder­ 171
Disease­ 171
Syndrome­ 172
Diagnosis­ 172
Differential­Diagnosis­ 172
Risk­Factor­ 172
Etiology­ 172
Biomarkers­ 172
Modern­Western­Medicine­ 174
Precision­Medicine­ 174
­Traditional­Definitions­of Chronic­Pancreatitis­ 174
­Mechanistic­Definition­of Chronic­Pancreatitis­ 174
­Progressive­Model­of CP­ 175
­Risk­Factors­and Etiologies­ 175
Pathogenic­Genetic­Mutations­ 176
Genetic­Risk­Factors­ 176
­Subtypes­of Inflammatory­Diseases­of the Pancreas­ 176
Acute­Pancreatitis­ 176
Recurrent­Acute­Pancreatitis­ 177
Hereditary­Pancreatitis­ 177
Familial­Pancreatitis­ 177
Tropical­Pancreatitis­ 177
Mendelian­Syndromes­Involving­the Pancreas­ 177
Complex­Pancreatic­Disorders­ 177
Minimal­Change­Chronic­Pancreatitis­ 177
­References­ 177