Pancreatitis..fasting,Antibiotics and Surgery..What is new?

This is a kind of Practice changing piece of data in the management of acute Pancreatitis. Here is the summary of updated literature, and it covers the recent updated in the three pillars of acute pancreatitis management

1-feeding..the question is to feed or not?
2-Antibiotics..the question is to give or not?
3-Surgery..the question to do or not?

Here are the answers

Regarding Feeding, the answer is "FEED ", Cochrane review in 2010  reached the conclusion – feed patients. In fact fasting has not been shown to help and probably increases the length of admission.  it is always taught that  feeding can increase enzyme production and cause “auto-digestion” – but according to the recent evidence it just aren’t so – they get better quicker and don’t suffer worse inflammation / mortality etc.  And if you have a nasogastric tube in – then that is fine – it does not need to be a nasojejunal tube to avoid the dreaded enzymes.

Now the second Question, Antibiotics to give or not? The old minded school always propose that acute pancreatitis is a sterile process and no need for antibiotics.
However things change and IV Abs have been used in the severe, necrotic end of the spectrum of disease with some benefit. A meta-analysis in Annals of Surgery suggested a benefit – but it was not an overwhelming one to my reading.  However this review suggested IV meropenem was a good thing for a necrotic collection.

The last question is Shall we take the patient to OR? The short answer is – not initially, a delayed surgical strategy seems to be beneficial. Surgery is probably best reserved for the true necrotic collection (necrosectomy) with a washout.

Evidence-Based Treatment of Acute Pancreatitis

A Look at Established Paradigms

Stefan Heinrich, MD,^* Markus Schäfer, MD,^* Valentin Rousson, PhD,^† and Pierre-Alain Clavien, MD, PhD^*

Ann Surg. 2006 February; 243(2): 154–168

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Enteral versus parenteral nutrition for acute pancreatitisMohammed Al-Omran^1,*, Zaina H AlBalawi², Mariam F Tashkandi³, Lubna A Al-Ansary⁴