Treatment of Pancreatic Diseases

Treatment of acute pancreatitis should be started as early as possible because fluid resuscitation in the first 24 h is of the utmost importance. Pain should be alleviated and early changes to nutrition considered. Antibiotics should not be introduced unless signs of systemic inflammatory response syndrome with suspicion of infection, concomitant biliary infection, or another organ infection are present. Various local complications can occur, which may be treated conservatively, minimally invasively, or surgically. Early endoscopic biliary decompression should be considered in patients with biliary pancreatitis. For chronic pancreatitis, lifestyle modifications should be encouraged, and pain relief medications should be gradually introduced. Patients with obstructive forms of chronic pancreatitis might benefit from endoscopic treatment, whereas surgical treatment should be considered for patients with disabling pain that cannot be controlled by medical treatment and is refractory to endoscopic treatment. Pancreatic exocrine insufficiency is often difficult to define and should be treated with pancreatic enzyme replacement therapy. Pancreatic cancer has a poor prognosis, and its management depends on the disease stage. Generally, in cases of resectable illness, surgery should be considered, with postoperative chemotherapy. Locally advanced disease (unresectable) can be treated with chemo(radio)therapy or stereotactic body radiotherapy; the best supportive care should be offered to patients with poor performance status. Systemic chemotherapy should be considered for patients with metastatic disease, and supportive care and palliative treatment should be provided.