Resumen
En los últimos años se han producido grandes cambios en el manejo de la pancreatitis aguda. Las razones son múltiples: conocemos en detalle la fisiopatología, existen más y mejores herramientas para tratar a los pacientes críticos en forma general, hay avances en cuanto al soporte nutricional, mayor conocimiento sobre la prevención y tratamiento de las infecciones pancreáticas, y sin dudas un cambio radical en las diferentes técnicas quirúrgicas.
El objetivo de este artículo es revisar dichas recomendaciones y actualizarlas, unificar criterios para el manejo integral de la pancreatitis aguda potencialmente grave que ingresa a los cuidados intensivos.
Han participado de la confección de este texto, médicos intensivistas y cirujanos expertos en el manejo de esta patología. Posteriormente dicho documento se ha discutido y consensuado en el grupo de Patologías digestivas Críticas de la Sociedad Argentina de Terapia Intensiva.
Citas
<p class="MsoNormal" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 36.0pt; text-align: justify; text-justify: inter-ideograph; text-indent: -36.0pt; line-height: 200%;"><strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US">1.</span></strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US"> Cappell MS. Acute pancreatitis: etiology, clinical presentation, diagnosis, and therapy. <em>Med Clin North Am. </em>Jul 2008;92(4):889-923.</span></p> <p class="MsoNormal" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 36.0pt; text-align: justify; text-justify: inter-ideograph; text-indent: -36.0pt; line-height: 200%;"><strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US">2.</span></strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US"> Van Woerkom RC, Adler DG. Acute pancreatitis: Contemporary Diagnosis and Management. <em>J Clin Outcomes Manag. </em>Jan 2012;19(1):13-26.</span></p> <p class="MsoNormal" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 36.0pt; text-align: justify; text-justify: inter-ideograph; text-indent: -36.0pt; line-height: 200%;"><strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US">3.</span></strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US"> Cruz-Santamaria DM, Taxonera C, Giner M. Update on pathogenesis and clinical management of acute pancreatitis. <em>World J Gastrointest Pathophysiol. </em>Jun 15 2012;3(3):60-70.</span></p> <p class="MsoNormal" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 36.0pt; text-align: justify; text-justify: inter-ideograph; text-indent: -36.0pt; line-height: 200%;"><strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US">4.</span></strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US"> Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. <em>Gut. </em>Jan 2013;62(1):102-111.</span></p> <p class="MsoNormal" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 36.0pt; text-align: justify; text-justify: inter-ideograph; text-indent: -36.0pt; line-height: 200%;"><strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US">5.</span></strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US"> Dellinger EP, Forsmark CE, Layer P, et al. Determinant-based classification of acute pancreatitis severity: an international multidisciplinary consultation. <em>Ann Surg. </em>Dec 2012;256(6):875-880.</span></p> <p class="MsoNormal" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 36.0pt; text-align: justify; text-justify: inter-ideograph; text-indent: -36.0pt; line-height: 200%;"><strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US">6.</span></strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US"> De Waele JJ. Acute pancreatitis. <em>Curr Opin Crit Care. </em>Apr 2014;20(2):189-195.</span></p> <p class="MsoNormal" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 36.0pt; text-align: justify; text-justify: inter-ideograph; text-indent: -36.0pt; line-height: 200%;"><strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US">7.</span></strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US"> Otsuki M, Takeda K, Matsuno S, et al. Criteria for the diagnosis and severity stratification of acute pancreatitis. <em>World J Gastroenterol. </em>Sep 21 2013;19(35):5798-5805.</span></p> <p class="MsoNormal" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 36.0pt; text-align: justify; text-justify: inter-ideograph; text-indent: -36.0pt; line-height: 200%;"><strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US">8.</span></strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US"> Wu BU, Johannes RS, Sun X, Tabak Y, Conwell DL, Banks PA. The early prediction of mortality in acute pancreatitis: a large population-based study. <em>Gut. </em>Dec 2008;57(12):1698-1703.</span></p> <p class="MsoNormal" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 36.0pt; text-align: justify; text-justify: inter-ideograph; text-indent: -36.0pt; line-height: 200%;"><strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US">9.</span></strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US"> Isenmann R, Rau B, Beger HG. Early severe acute pancreatitis: characteristics of a new subgroup. <em>Pancreas. </em>Apr 2001;22(3):274-278.</span></p> <p class="MsoNormal" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 36.0pt; text-align: justify; text-justify: inter-ideograph; text-indent: -36.0pt; line-height: 200%;"><strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US">10.</span></strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US"> Ranson JH, Rifkind KM, Roses DF, Fink SD, Eng K, Localio SA. Objective early identification of severe acute pancreatitis. <em>Am J Gastroenterol. </em>Jun 1974;61(6):443-451.</span></p> <p class="MsoNormal" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 36.0pt; text-align: justify; text-justify: inter-ideograph; text-indent: -36.0pt; line-height: 200%;"><strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US">11.</span></strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US"> Ranson JH, Rifkind KM, Roses DF, Fink SD, Eng K, Spencer FC. Prognostic signs and the role of operative management in acute pancreatitis. <em>Surg Gynecol Obstet. </em>Jul 1974;139(1):69-81.</span></p> <p class="MsoNormal" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 36.0pt; text-align: justify; text-justify: inter-ideograph; text-indent: -36.0pt; line-height: 200%;"><strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US">12.</span></strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US"> Imrie CW, Benjamin IS, Ferguson JC, et al. A single-centre double-blind trial of Trasylol therapy in primary acute pancreatitis. <em>Br J Surg. </em>May 1978;65(5):337-341.</span></p> <p class="MsoNormal" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 36.0pt; text-align: justify; text-justify: inter-ideograph; text-indent: -36.0pt; line-height: 200%;"><strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US">13.</span></strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US"> Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. <em>Crit Care Med. </em>Oct 1985;13(10):818-829.</span></p> <p class="MsoNormal" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 36.0pt; text-align: justify; text-justify: inter-ideograph; text-indent: -36.0pt; line-height: 200%;"><strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US">14.</span></strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US"> Larvin M, McMahon MJ. APACHE-II score for assessment and monitoring of acute pancreatitis. <em>Lancet. </em>Jul 22 1989;2(8656):201-205.</span></p> <p class="MsoNormal" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 36.0pt; text-align: justify; text-justify: inter-ideograph; text-indent: -36.0pt; line-height: 200%;"><strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US">15.</span></strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US"> Marshall JC, Cook DJ, Christou NV, Bernard GR, Sprung CL, Sibbald WJ. Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome. <em>Crit Care Med. </em>Oct 1995;23(10):1638-1652.</span></p> <p class="MsoNormal" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 36.0pt; text-align: justify; text-justify: inter-ideograph; text-indent: -36.0pt; line-height: 200%;"><strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US">16.</span></strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US"> Vincent JL, Moreno R, Takala J, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. <em>Intensive Care Med. </em>Jul 1996;22(7):707-710.</span></p> <p class="MsoNormal" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 36.0pt; text-align: justify; text-justify: inter-ideograph; text-indent: -36.0pt; line-height: 200%;"><strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US">17.</span></strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US"> Balthazar EJ, Ranson JH, Naidich DP, Megibow AJ, Caccavale R, Cooper MM. Acute pancreatitis: prognostic value of CT. <em>Radiology. </em>Sep 1985;156(3):767-772.</span></p> <p class="MsoNormal" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 36.0pt; text-align: justify; text-justify: inter-ideograph; text-indent: -36.0pt; line-height: 200%;"><strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US">18.</span></strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US"> Mortele KJ, Wiesner W, Intriere L, et al. A modified CT severity index for evaluating acute pancreatitis: improved correlation with patient outcome. <em>AJR Am J Roentgenol. </em>Nov 2004;183(5):1261-1265.</span></p> <p class="MsoNormal" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 36.0pt; text-align: justify; text-justify: inter-ideograph; text-indent: -36.0pt; line-height: 200%;"><strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US">19.</span></strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US"> Bollen TL, Singh VK, Maurer R, et al. A comparative evaluation of radiologic and clinical scoring systems in the early prediction of severity in acute pancreatitis. <em>Am J Gastroenterol. </em>Apr 2011;107(4):612-619.</span></p> <p class="MsoNormal" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 36.0pt; text-align: justify; text-justify: inter-ideograph; text-indent: -36.0pt; line-height: 200%;"><strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US">20.</span></strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US"> Warndorf MG, Kurtzman JT, Bartel MJ, et al. Early fluid resuscitation reduces morbidity among patients with acute pancreatitis. </span><em><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif";">Clin Gastroenterol Hepatol. </span></em><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif";">Aug 2011;9(8):705-709.</span></p> <p class="MsoNormal" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 36.0pt; text-align: justify; text-justify: inter-ideograph; text-indent: -36.0pt; line-height: 200%;"><strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif";">21.</span></strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif";"> de-Madaria E, Soler-Sala G, Sanchez-Paya J, et al. </span><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US">Influence of fluid therapy on the prognosis of acute pancreatitis: a prospective cohort study. <em>Am J Gastroenterol. </em>Oct 2011;106(10):1843-1850.</span></p> <p class="MsoNormal" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 36.0pt; text-align: justify; text-justify: inter-ideograph; text-indent: -36.0pt; line-height: 200%;"><strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US">22.</span></strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US"> Gardner TB, Vege SS, Pearson RK, Chari ST. Fluid resuscitation in acute pancreatitis. <em>Clin Gastroenterol Hepatol. </em>Oct 2008;6(10):1070-1076.</span></p> <p class="MsoNormal" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 36.0pt; text-align: justify; text-justify: inter-ideograph; text-indent: -36.0pt; line-height: 200%;"><strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US">23.</span></strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US"> Mao EQ, Fei J, Peng YB, Huang J, Tang YQ, Zhang SD. Rapid hemodilution is associated with increased sepsis and mortality among patients with severe acute pancreatitis. <em>Chin Med J (Engl). </em>Jul 2010;123(13):1639-1644.</span></p> <p class="MsoNormal" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 36.0pt; text-align: justify; text-justify: inter-ideograph; text-indent: -36.0pt; line-height: 200%;"><strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US">24.</span></strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US"> IAP/APA evidence-based guidelines for the management of acute pancreatitis. <em>Pancreatology. </em>Jul-Aug 2013;13(4 Suppl 2):e1-15.</span></p> <p class="MsoNormal" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 36.0pt; text-align: justify; text-justify: inter-ideograph; text-indent: -36.0pt; line-height: 200%;"><strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US">25.</span></strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US"> Petrov MS PR, Emelyanov NV. Systematic review: nutritional support in acute pacnreatitis. <em>Alim Pharmacol Ther. </em>2008(28):704-712.</span></p> <p class="MsoNormal" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 36.0pt; text-align: justify; text-justify: inter-ideograph; text-indent: -36.0pt; line-height: 200%;"><strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US">26.</span></strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US"> Gianotti L, Meier R, Lobo DN, et al. ESPEN Guidelines on Parenteral Nutrition: pancreas. <em>Clin Nutr. </em>Aug 2009;28(4):428-435.</span></p> <p class="MsoNormal" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 36.0pt; text-align: justify; text-justify: inter-ideograph; text-indent: -36.0pt; line-height: 200%;"><strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US">27.</span></strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US"> McClave SA, Taylor BE, Martindale RG, et al. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). </span><em><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif";">JPEN J Parenter Enteral Nutr. </span></em><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif";">Feb 2016;40(2):159-211.</span></p> <p class="MsoNormal" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 36.0pt; text-align: justify; text-justify: inter-ideograph; text-indent: -36.0pt; line-height: 200%;"><strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif";">28.</span></strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif";"> Yi F GL, Zhao J e t al. </span><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US">Meta-analysis: total parenteral nutrition versus total enteral nutrition in predicted severe acute pancreatitis . <em>Intern Med. </em>2012(51):523-530.</span></p> <p class="MsoNormal" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 36.0pt; text-align: justify; text-justify: inter-ideograph; text-indent: -36.0pt; line-height: 200%;"><strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US">29.</span></strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US"> Li JY YT, Chen YH, Yuan YH, Zhong W, Zhao LN, Chen QK. Enteral nutrition within 48hs of admission imporves clinical outcomes of acute pacnretitis by reducing complicaction: a meta-analysis. <em>PLOS one. </em>2013;8(6):1-12.</span></p> <p class="MsoNormal" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 36.0pt; text-align: justify; text-justify: inter-ideograph; text-indent: -36.0pt; line-height: 200%;"><strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US">30.</span></strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US"> Sun JK MX, Li WQ, Tong ZH, Li J, Zheng SY. Effects of early enteral nutrition on immune function of severe acute pancreatitis patients. <em>Gastroenterology. </em>2013;19:917-922.</span></p> <p class="MsoNormal" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 36.0pt; text-align: justify; text-justify: inter-ideograph; text-indent: -36.0pt; line-height: 200%;"><strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US">31.</span></strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US"> O´keefe SJ LR, Li J, et al. Trypsin secretion and turnover in patients with acute pancreatitis. <em>Am J Physiol Gastrointest Liver Physiol. </em>2005;289:G181-G187.</span></p> <p class="MsoNormal" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 36.0pt; text-align: justify; text-justify: inter-ideograph; text-indent: -36.0pt; line-height: 200%;"><strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US">32.</span></strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US"> Chang YS FH, Xiao YM, Liu JC. Nasogastric or nasojejunal feeding in predicted severe acute pancreatitis: a meta-analysis. <em>Critical Care. </em>2013;17(3):118-127.</span></p> <p class="MsoNormal" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 36.0pt; text-align: justify; text-justify: inter-ideograph; text-indent: -36.0pt; line-height: 200%;"><strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US">33.</span></strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US"> Petrov MS LB, Pylypchuk RD, McIlroy K, Phillips AR, Windsor JA. Systematic review and meta-analysis of enteral nutrition formulations in acute pancreatitis. </span><em><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif";">Br J Surg. </span></em><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif";">2009;96:1243-1242.</span></p> <p class="MsoNormal" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 36.0pt; text-align: justify; text-justify: inter-ideograph; text-indent: -36.0pt; line-height: 200%;"><strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif";">34.</span></strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif";"> Mirtallo JM FA, McClave SA, Jensen GL, Waitzberg DL, Davies AR. </span><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US">International consensus guidelines for nutrition therapy in pancreatitis. <em>JPEN J Parenter Enetral Nutr. </em>2012;36:284-291.</span></p> <p class="MsoNormal" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 36.0pt; text-align: justify; text-justify: inter-ideograph; text-indent: -36.0pt; line-height: 200%;"><strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US">35.</span></strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US"> De Waele JJ. Use of antibiotics in severe acute pancreatitis. <em>Expert Rev Anti Infect Ther. </em>Mar 2010;8(3):317-324.</span></p> <p class="MsoNormal" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 36.0pt; text-align: justify; text-justify: inter-ideograph; text-indent: -36.0pt; line-height: 200%;"><strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US">36.</span></strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US"> De Waele JJ. Rational use of antimicrobials in patients with severe acute pancreatitis. <em>Semin Respir Crit Care Med. </em>Apr 2011;32(2):174-180.</span></p> <p class="MsoNormal" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 36.0pt; text-align: justify; text-justify: inter-ideograph; text-indent: -36.0pt; line-height: 200%;"><strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US">37.</span></strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US"> Tenner S, Baillie J, DeWitt J, Vege SS. American College of Gastroenterology guideline: management of acute pancreatitis. </span><em><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif";">Am J Gastroenterol. </span></em><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif";">Sep 2013;108(9):1400-1415; 1416.</span></p> <p class="MsoNormal" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 36.0pt; text-align: justify; text-justify: inter-ideograph; text-indent: -36.0pt; line-height: 200%;"><strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif";">38.</span></strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif";"> De Waele JJ, Rello J, Anzueto A, et al. </span><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US">Infections and use of antibiotics in patients admitted for severe acute pancreatitis: data from the EPIC II study. <em>Surg Infect (Larchmt). </em>Aug 2014;15(4):394-398.</span></p> <p class="MsoNormal" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 36.0pt; text-align: justify; text-justify: inter-ideograph; text-indent: -36.0pt; line-height: 200%;"><strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US">39.</span></strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US"> Cacopardo B, Pinzone M, Berretta S, et al. Localized and systemic bacterial infections in necrotizing pancreatitis submitted to surgical necrosectomy or percutaneous drainage of necrotic secretions. <em>BMC Surg. </em>2013;13 Suppl 2:S50.</span></p> <p class="MsoNormal" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 36.0pt; text-align: justify; text-justify: inter-ideograph; text-indent: -36.0pt; line-height: 200%;"><strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US">40.</span></strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US"> Xue P, Deng LH, Zhang ZD, et al. Effect of antibiotic prophylaxis on acute necrotizing pancreatitis: results of a randomized controlled trial. <em>J Gastroenterol Hepatol. </em>May 2009;24(5):736-742.</span></p> <p class="MsoNormal" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 36.0pt; text-align: justify; text-justify: inter-ideograph; text-indent: -36.0pt; line-height: 200%;"><strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US">41.</span></strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US"> Tse F, Yuan Y, Leontiadis GI. The role of endoscopic retrograde cholangiopancreatography in acute pancreatitis. <em>Am J Gastroenterol. </em>Mar 2014;109(3):443-444.</span></p> <p class="MsoNormal" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 36.0pt; text-align: justify; text-justify: inter-ideograph; text-indent: -36.0pt; line-height: 200%;"><strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US">42.</span></strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US"> Folsch UR, Nitsche R, Ludtke R, Hilgers RA, Creutzfeldt W. Early ERCP and papillotomy compared with conservative treatment for acute biliary pancreatitis. The German Study Group on Acute Biliary Pancreatitis. <em>N Engl J Med. </em>Jan 23 1997;336(4):237-242.</span></p> <p class="MsoNormal" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 36.0pt; text-align: justify; text-justify: inter-ideograph; text-indent: -36.0pt; line-height: 200%;"><strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US">43.</span></strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US"> Neoptolemos JP, Carr-Locke DL, London NJ, Bailey IA, James D, Fossard DP. Controlled trial of urgent endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy versus conservative treatment for acute pancreatitis due to gallstones. <em>Lancet. </em>Oct 29 1988;2(8618):979-983.</span></p> <p class="MsoNormal" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 36.0pt; text-align: justify; text-justify: inter-ideograph; text-indent: -36.0pt; line-height: 200%;"><strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US">44.</span></strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US"> Tse F, Yuan Y. Early routine endoscopic retrograde cholangiopancreatography strategy versus early conservative management strategy in acute gallstone pancreatitis. <em>Cochrane Database Syst Rev. </em>2012;5:CD009779.</span></p> <p class="MsoNormal" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 36.0pt; text-align: justify; text-justify: inter-ideograph; text-indent: -36.0pt; line-height: 200%;"><strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US">45.</span></strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US"> Petrov MS, Shanbhag S, Chakraborty M, Phillips AR, Windsor JA. Organ failure and infection of pancreatic necrosis as determinants of mortality in patients with acute pancreatitis. <em>Gastroenterology. </em>Sep 2010;139(3):813-820.</span></p> <p class="MsoNormal" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 36.0pt; text-align: justify; text-justify: inter-ideograph; text-indent: -36.0pt; line-height: 200%;"><strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US">46.</span></strong><span style="font-size: 10.0pt; line-height: 200%; font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;" lang="EN-US"> van Santvoort HC, Besselink MG, Bakker OJ, et al. A step-up approach or open necrosectomy for necrotizing pancreatitis. <em>N Engl J Med. </em>Apr 22 2010;362(16):1491-1502.</span></p>
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