Acute Pancreatitis: Non-surgical Therapies Including Gallstone Management

Supportive care including adequate fluid resuscitation, pain management, and nutrition are the cornerstone of the management of acute pancreatitis in the early phase. The systemic inflammatory response syndrome and subsequent compensatory anti-inflammatory response syndrome in the early phase of the disease can give rise to infections, organ failure, and ultimately mortality. To date, an active treatment for acute pancreatitis to prevent such a complicated course is lacking. Prophylactic antibiotics and probiotics have not shown to be effective. The use of omega-3 fatty acids, butyrate, and microbiome modulation is currently being investigated. In addition to supportive care, it is important to determine the cause of pancreatitis for prevention of recurrence and the presence of any associated problems. Gallstones are the most common cause of acute pancreatitis and can also cause common bile duct obstruction. In case of cholangitis in patients with biliary pancreatitis, urgent endoscopic retrograde cholangiopancreatography is indicated. Same-admission laparoscopic cholecystectomy is recommended in patients with mild biliary pancreatitis to reduce the rate of recurrent gallstone disease. In patients with necrotizing pancreatitis, delayed cholecystectomy after 6 weeks is currently advised. In the 20% of patients with idiopathic pancreatitis, a repeat transabdominal ultrasound after discharge is advised. If this does not reveal biliary disease, an upper EUS should be performed as it will find a treatable cause in about 30% of patients.