Clinical Pancreatology for Practising Gastroenterologists and Surgeons

1 Cover

2 Title Page

3 Copyright Page

4 Contributors

5 Foreword

6 Preface

7 Dedication Page

8 Section I: Acute Pancreatitis 1 Acute Pancreatitis Introduction Causes Laboratory Diagnosis Imaging Risk Stratification Classification Treatment Long‐term Sequelae References 2 How to Deal with the Etiological Diagnosis of Acute Pancreatitis in Clinical Practice? Introduction Etiological Diagnosis Investigative Work‐up Concluding Remarks References 3 Definition of Complications and Severity of Acute Pancreatitis for Clinical Practice Background The Atlanta Classification 1992 The Revised Atlanta Classification 2012 The Determinant‐Based Classification Conclusion References 4 Early Prediction of Severity in Acute Pancreatitis Introduction Available Prediction Tools Scoring Systems Limitations and Future of Current Scoring Systems and Predictive Markers Artificial Intelligence and Biomarkers: the Future? References 5 Role of CT Scan in Acute Pancreatitis CT Imaging in Acute Pancreatitis Timing of CT in Acute Pancreatitis Limitations of CT Imaging Conclusion Disclosures References 6 Role of MRI in Acute Pancreatitis Introduction MRI and MRCP Protocol for Pancreas Examination Interstitial Edematous Pancreatitis Necrotizing Pancreatitis Complications of Acute Pancreatitis References 7 Treatment of Acute Pancreatitis in The Emergency Room Introduction Early Diagnosis in the Emergency Room Initial Work‐up for Etiology Severity Assessment, Triage, and Disposition Specialty Consultation Management Summary References 8 Acute Pancreatitis Introduction Acute Pancreatitis and Systemic Complications: Definitions, Importance, and Incidence Monitoring Respiratory Function and Management of Respiratory Failure Shock: Volume Management and Hemodynamic Monitoring Acute Renal Failure: Early Detection and Management Other Systemic Complications Associated with Acute Pancreatitis Abdominal Compartment Syndrome References 9 Guidelines for the Treatment of Pain in Acute Pancreatitis Introduction Nonsteroidal Anti‐inflammatory Drugs Opioid Analgesics Epidural Analgesia Local Anesthetics Summary References 10 Nutrition in the Acute Phase of Pancreatitis Why When How What to Feed References 11 Oral Refeeding in Acute Pancreatitis Introduction What is the Optimal Timing of Refeeding in AP? How Should Oral Refeeding be Scheduled? What are the Predictors of Oral Feeding Intolerance in AP Patients? Summary and Recommendations References 12 Pharmacological Therapy for Acute Pancreatitis Introduction Calcium Toxicity Mitochondrial Dysfunction Autophagy Acinar Cell Secretion, Serine Proteases, and Serine Protein Kinases Immune Cells/Inflammation CFTR Design of Future Clinical Trials Conclusion References 13 Indication and Optimal Timing of ERCP in Acute Pancreatitis Introduction ERCP in the Setting of Acute Biliary Pancreatitis Additional Applications of ERCP in the Setting of Acute Pancreatitis Conclusions Disclosures References 14 How to Deal with Infected Pancreatic Necrosis? Introduction Prevention of Infection of (Peri)pancreatic Necrosis Diagnosis of Infected (Peri)pancreatic Necrosis How to Deal with Infected (Peri)pancreatic Necrosis References 15 Minimally Invasive Surgical Necrosectomy in Clinical Practice Introduction Percutaneous Drainage Sinus Tract Endoscopy Endoscopic (Endoluminal) Approach Retroperitoneal Approach Laparoscopic Transperitoneal Approach References Note 16 Endoscopic Necrosectomy in Clinical Practice Introduction Management of Symptomatic Pseudocysts Management of Symptomatic Walled‐off Necrosis Conclusion References 17 Management of Acute Pancreatic Pseudocyst Introduction Evaluation Drainage Therapy Disconnected Pancreatic Duct Syndrome Complications Conclusion References 18 The Disconnected Main Pancreatic Duct Syndrome Introduction Epidemiology Risk Factors and Predictors of DPDS Clinical Significance Clinical Presentation Diagnosis Treatment Conclusions References 19 Vasculature Complications in Pancreatitis Venous Complications Arterial Complications Summary References 20 Acute Relapsing Pancreatitis Introduction Definition Burden Demographics Etiology Diagnostic Work‐up Natural History and Risk of Progression Preventing Recurrences and Disease Progression Conclusion Acknowledgment References 21 Diagnosis and Therapeutic Approach to Pancreatic Exocrine Insufficiency after Acute Pancreatitis Introduction Symptoms Diagnosis Management Summary References 22 Asymptomatic Chronic Elevation of Serum Pancreatic Enzymes Introduction Physiology of Pancreatic Enzymes Pancreatic Abnormalities in Patients with Pancreatic Hyperenzymemia Gastrointestinal Diseases and Pancreatic Hyperenzymemia Macroenzymemia Systemic Conditions Associated with Hyperenzymemia Drug‐induced Hyperenzymemia Extrapancreatic Abnormalities in Patients with Hyperenzymemia Benign Pancreatic Hyperenzymemia (Gullo Syndrome) Algorithm for Management of CAPH (Figure 22.2) Conclusions References

9 Section II: Chronic Pancreatitis 23 Definition and Etiology of Chronic Pancreatitis Definition of Key Terms and Concepts Traditional Definitions of Chronic Pancreatitis Mechanistic Definition of Chronic Pancreatitis Progressive Model of CP Risk Factors and Etiologies Subtypes of Inflammatory Diseases of the Pancreas References 24 Epidemiology of Chronic Pancreatitis Why is Chronic Pancreatitis Epidemiology so Imprecise? Epidemiology Why are Reported Data on Incidence and Prevalence of Chronic Pancreatitis Discrepant? General Characteristics of Patients with Chronic Pancreatitis Mortality Conclusion References 25 Alcoholic Chronic Pancreatitis and the Impact of Alcohol and Smoking Cessation in Chronic Pancreatitis Introduction Epidemiology Direct Cellular Effects of Alcohol on the Pancreas Individual Susceptibility to Alcoholic Pancreatitis Impact of Alcohol and Smoking Cessation Summary References 26 What is Relevant on Genetics in Chronic Pancreatitis for Clinical Practice? What Genes and When to Evaluate Them? Introduction How to Screen Probability of Identifying Genetic Variants in CP Patients Which Genes are Clinically Relevant? Screening for Cystic Fibrosis Transmembrane Conductance Regulator Gene Variants What to do When a Variant has been Identified? Increased Risk for Pancreatic Cancer in Chronic Pancreatitis Patients How can Genetic Association Studies Change our Clinical Practice? References 27 Pancreas Divisum and Other Potential Obstructive Causes of Chronic Pancreatitis Introduction Idiopathic Pancreatitis Pancreas Divisum Other Potential Obstructive Causes of Chronic Pancreatitis Disclosures References 28 What to do in Clinical Practice Before Defining a Chronic Pancreatitis as Idiopathic? A Practical Protocol Introduction Etiologies of Chronic Pancreatitis Diagnostic Approach Conclusion References 29 Computed Tomography for the Diagnosis, Evaluation of Severity, and Detection of Complications of Chronic Pancreatitis in Clinical Practice Introduction Conventional CT in the Evaluation of Chronic Pancreatitis Advanced CT Techniques Future Challenges in CT Imaging Conclusion References 30 Role of MRI and MRCP in the Diagnosis, Evaluation of Severity, and Detection of Complications of Chronic Pancreatitis in Clinical Practice Introduction Diagnosis Severity Complications Conclusion References 31 Role of Endoscopic Ultrasound and Associated Methods (Elastography, Contrast Enhancement) in the Diagnosis, Evaluation of Severity, and Detection of Complications of Chronic Pancreatitis in Clinical Practice Introduction EUS in the Diagnosis of Chronic Pancreatitis EUS for the Evaluation of Complications of Chronic Pancreatitis Conclusions References 32 Endoscopic Pancreatic Function Test for the Functional Diagnosis of Chronic Pancreatitis Introduction History of Pancreas Function Tests Pancreas Function Tests Conclusions References 33 Role of Pancreatic Function Tests for the Diagnosis