Acute pancreatitis : new frontiers in diagnosis and treatment

Acute pancreatitis is an acute inflammation of the pancreas mostly caused by gallstones and alcohol abuse. Around 15 to 20% of patients show a severe clinical course, which is characterised by multiple organ failure and necrosis of the pancreatic parenchyma and/ or peripancreatic fat tissue. In around 30% of patients with necrotising pancreatitis, secondary infection of necrosis occurs, probably due to bacterial translocation from the patient’s own gut. Infected necrosis is an indication for intervention and is associated with 30% mortality. There are relatively few prospective studies on acute pancreatitis. This is probably explained by the fact that acute pancreatitis is a complicated disease with a relatively low incidence in the severe form. Even international high volume expert centres do not treat enough patients with necrotising pancreatitis to, individually, perform adequately powered prospective studies. Therefore, inter-institutional collaboration is the key. In 2002, we formed the Dutch Pancreatitis Study Group, with the aim to improve outcome of patients with acute (necrotising) pancreatitis through centralisation, consultation and multicentre research. The Dutch Pancreatitis Study Group now comprises over 20 hospitals, including all Dutch University Medical Centres, in which many surgeons, gastroenterologists, radiologists and other specialists actively participate. This thesis presents much of the clinical research performed by the Dutch Pancreatitis Study Group in the period of 2004-2010.