Article information
Resumen
El presente artículo recopila la evidencia más reciente sobre los últimos avances en el concepto, diagnóstico y tratamiento de la pancreatitis aguda. El concepto de pancreatitis aguda y sus complicaciones está cambiando, y la presencia de fallo orgánico persistente es esencial para clasificar a un paciente como grave. En este contexto, un incremento en la permeabilidad intestinal se demuestra como un fenómeno precoz con importantes repercusiones pronósticas. La ecografía endoscópica se confirma como la exploración de primera elección en el estudio de pacientes con pancreatitis aguda idiopática o de probable etiología biliar. Una reposición hidroelectrolítica agresiva durante las primeras horas de enfermedad es clave para un curso clínico favorable. El tratamiento conservador y el empleo de necrosectomía endoscópica están desplazando al abordaje quirúrgico como tratamiento de primera elección de la necrosis pancreática infectada. Por último, se discuten en este artículo las últimas evidencias en la prevención de pancreatitis aguda tras la colangiopancreatografía retrógrada endoscópica.
Palabras clave:
Etiopatogenia
Fisiopatología
Síndrome de respuesta inflamatoria sistémica
Colangiopancreatografía retrógrada endoscópica
Ultrasonografía endoscópica
Necrosectomía
Complicaciones
Abstract
The present article reports the most recent evidence on the latest advances in the definition, diagnosis and treatment of acute pancreatitis. The concept of acute pancreatitis and its complications is changing and the presence of persistent organ failure is essential to classify a patient as having severe disease. In this context, increased intestinal permeability is seen as an early phenomenon with important prognostic repercussions. Endoscopic ultrasonography is confirmed as the investigation of choice in patients with idiopathic acute pancreatitis or suspected acute biliary pancreatitis. Aggressive water and electrolyte replacement in the first few hours after onset is the key to a favorable clinical course. Conservative treatment and the use of endoscopic necrosectomy are replacing surgery as the treatment of choice of infected pancreatic necrosis. Lastly, the present article discusses the latest evidence on the prevention of post- endoscopic retrograde cholangiopancreatography (ERCP) acute pancreatitis.
Key words:
Etiopathogenesis
physiopathology
systemic inflammatory response syndrome
endoscopic retrograde cholangiopancreatography
endoscopic ultrasound
necrosectomy
complications
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