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Acute Pancreatitis and Its Complications: Current Diagnostics and Management

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Gastroenterology & Hepatopancreatobiliary Medicine".

Deadline for manuscript submissions: 20 September 2026 | Viewed by 12475

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Dr. Beata Jabłońska

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Department of Digestive Tract Surgery, Medical University of Silesia, Katowice, Poland
Interests: gastrointestinal surgery; oncological surgery; vascular surgery; gastroenterology; angiology; oncology; nutritional status; nutrition
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Special Issue Information

Dear Colleagues,

Acute pancreatitis (AP) is defined as acute inflammation of the pancreas leading to potential local or systemic complications. According to the 2012 revision of the Atlanta Classification, AP is categorized into mild AP (MAP), moderately severe AP (MSAP), and severe AP (SAP). Assessment of AP severity is crucial for appropriate management, and various scores are used to assess the AP severity.

In 5–10% patients, pancreatic and/or peripancreatic necrosis is observed. Pancreatic and peripancreatic necrosis may remain solid or liquefy, remain sterile or become infected, persist, or disappear over time.

Atlanta classification has distinguished acute peripancreatic fluid collection (APFC), pancreatic pseudocyst (PPC), acute necrotic collection (ANC), and walled-off necrosis (WON). Recently, a significant evolution of the management in patients with AP complications, including PPC and WON, has been observed. The older surgical methods of treatment have been replaced by less invasive percutaneous radiological and endoscopic approaches. This Special Issue on “Acute Pancreatitis and Its Complications – Current Diagnostics and Management” will cover all aspects of diagnostic and therapeutic methods used in AP patients. I invite original research and review papers regarding various laboratory tests and radiological investigations, prognostic scores, and surgical and less invasive techniques used in AP patients.

Dr. Beata Jabłońska
Guest Editor

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Keywords

acute pancreatitis
pancreas
pancreatic and peripancreatic necrosis
management
less invasive percutaneous radiological and endoscopic approaches

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Published Papers (5 papers)

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Research

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16 pages, 1147 KB

Open AccessArticle

Risk Factors for Post-ERCP Pancreatitis: Impact of Transpancreatic Septotomy, Needle–Knife Precut, and Duodenal Diverticulum in 1226 Procedures

by Mehmet Kasım Aydın and Mehmet Cudi Tuncer

J. Clin. Med. 2026, 15(2), 504; https://doi.org/10.3390/jcm15020504 - 8 Jan 2026

Cited by 1 | Viewed by 837

Abstract

Background: Post-ERCP pancreatitis (PEP) remains the most common and clinically relevant adverse event following endoscopic retrograde cholangiopancreatography (ERCP). The impact of periampullary duodenal diverticulum and advanced cannulation techniques—particularly needle–knife precut sphincterotomy and transpancreatic septotomy (TPS)—on PEP risk remains debated. This study aimed to evaluate the association of these factors with PEP development in a large tertiary-center cohort. Methods: This retrospective study included 1226 patients who underwent ERCP between January 2018 and October 2022. Demographic, clinical, and procedural variables were recorded. Outcomes included PEP, hyperamylasemia, bleeding, and perforation. Univariable analyses were followed by multivariable logistic regression to identify independent predictors of PEP. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were calculated. Results: PEP occurred in 17.3% of the cohort. Needle–knife precut sphincterotomy and transpancreatic septotomy were frequently used advanced cannulation techniques and were both associated with an increased prevalence of PEP, with PEP occurring in 30.3% of patients undergoing needle–knife precut sphincterotomy and 56.9% of those undergoing transpancreatic septotomy. In the multivariable model, needle–knife precut independently increased PEP risk by 2.45-fold (aOR 2.45; 95% CI 1.78–3.36; p < 0.001), whereas TPS demonstrated the strongest association, increasing the risk nearly fivefold (aOR 4.92; 95% CI 2.98–8.11; p < 0.001). Female sex showed a nonsignificant trend toward increased PEP risk (aOR 1.28; 95% CI 0.96–1.69; p = 0.08). Periampullary duodenal diverticulum, pancreatic duct stenting, comorbidities, and age were not independently associated with PEP development (p > 0.05 for all). Conclusions: Needle–knife precut sphincterotomy and transpancreatic septotomy were independent predictors of PEP, with the highest risk observed for transpancreatic septotomy, whereas periampullary diverticulum and pancreatic duct stenting were not associated with increased risk. Full article

(This article belongs to the Special Issue Acute Pancreatitis and Its Complications: Current Diagnostics and Management)

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13 pages, 413 KB

Open AccessArticle

Prevalence and Related Factors of Post-ERCP Pancreatitis in Cholangiocarcinoma Patients: A Retrospective Study in Northeast Thailand

by Tanapoom Karntaumporn, Vasin Thanasukarn, Tharatip Srisuk, Vor Luvira, Theerawee Tipwaratorn, Apiwat Jareanrat, Krit Rattanarak, Khanisara Kraphunpongsakul, Natcha Khuntikeo, Jarin Chindaprasirt, Kulyada Eurboonyanun, Prakasit Sa-Ngiamwibool, Watcharin Loilome, Piya Prajumwongs and Attapol Titapun

J. Clin. Med. 2025, 14(20), 7286; https://doi.org/10.3390/jcm14207286 - 15 Oct 2025

Cited by 1 | Viewed by 1646

Abstract

Background/Objectives: Post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) is a frequent but insufficiently studied complication in cholangiocarcinoma (CCA). This study aimed to evaluate incidence and risk factors of PEP in CCA. Methods: We retrospectively reviewed 148 CCA patients who underwent ERCP between 2019 and 2022. Demographic, clinical, and procedural data were compared between patients with and without PEP, and logistic regression was used to identify independent predictors. Results: PEP occurred in 26.4% of patients, mostly aged ≥ 66 years, male, and with perihilar CCA. In PEP cases, metallic stents were frequently used, procedures often exceeded 60 min, and 28.2% developed post-ERCP cholangitis. Hospital stay was ≥4 days in nearly 90% of cases. PEP severity was mild (10.3%), moderate (61.5%), and severe (28.2%). Multivariate analysis showed older age, metallic stent placement, and post-ERCP cholangitis as independent risk factors, while bilirubin ≥ 15 mg/dL was protective. Conclusions: PEP occurred in over one-fourth of CCA patients, predominantly of moderate severity. Independent risk factors included older age, metallic stent placement, and post-ERCP cholangitis, whereas bilirubin ≥ 15 mg/dL was protective. Awareness of these factors may aid risk stratification and prevention in this high-risk group. Full article

(This article belongs to the Special Issue Acute Pancreatitis and Its Complications: Current Diagnostics and Management)

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16 pages, 994 KB

Open AccessArticle

Impact of Alcoholic Etiology on Mortality and Clinical Outcome in Acute Pancreatitis: A Retrospective Cohort Study Across the COVID-19 Pandemic

by Cristian-Nicolae Costea, Radu Seicean, Cristina Pojoga, Vlad-Ionuț Nechita, Irina Dragomir, Mihaela Oancea, Mariana Toma and Andrada Seicean

J. Clin. Med. 2025, 14(18), 6551; https://doi.org/10.3390/jcm14186551 - 17 Sep 2025

Viewed by 1985

Abstract

Background/Objectives: Alcoholic acute pancreatitis (AP) is a major cause of hospital admissions in Eastern Europe. However, data from secondary-care centers on the impact of the COVID-19 pandemic are limited. Methods: We retrospectively analyzed all adult AP admissions to a secondary-care hospital between March 2018 and March 2025. Cases were classified by etiology and grouped into pre-pandemic, pandemic, and post-pandemic periods. We compared demographic, clinical, severity, recurrence, outcome, resource use, and cost data between alcoholic and non-alcoholic AP. Results: Among 1096 patients (63.5% male; median age 55 years), alcohol was the leading etiology (40.1%), peaking during the pandemic. Alcoholic AP was more common in men, rural residents, and smokers, and less common in patients with obesity or diabetes. Recurrence was higher in alcoholic AP (21.8% vs. 15.9%; p = 0.015). Severe disease was more frequent in alcoholic than biliary AP (38.4% vs. 22.3%; p = 0.001). Overall mortality was 8.4%, declining after the pandemic (10.4% pre-pandemic vs. 6.5% post-pandemic). In multivariable Cox models, pleural effusion (HR 7.88; 95% CI 3.27–18.99) and age (HR 1.02; 95% CI 1.00–1.03) independently predicted mortality in the overall cohort. In alcoholic AP, pleural effusion was the only independent predictor (HR 13.19; 95% CI 2.48–70.08). In non-alcoholic AP, pleural effusion (HR 6.83; 95% CI 2.40–19.44) and signs of shock (HR 3.49; 95% CI 1.14–10.71) were independent predictors. Conclusions: Alcoholic AP was the most frequent etiology, with higher recurrence and severity than biliary AP, but alcoholic etiology itself did not predict mortality. Mortality drivers differed by etiology: pleural effusion in alcoholic AP, and pleural effusion plus signs of shock in non-alcoholic AP. ICU transfer was associated with death in descriptive analyses but was treated as a downstream mediator and not included in adjusted models. Full article

(This article belongs to the Special Issue Acute Pancreatitis and Its Complications: Current Diagnostics and Management)

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Review

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27 pages, 5450 KB

Open AccessEditor’s ChoiceReview

Pancreatic Pseudocysts: Evolution of Treatment Approaches

by Paulina Kluszczyk, Aleksandra Tobiasz, Adam Madej, Piotr Wosiewicz, Sławomir Mrowiec and Beata Jabłońska

J. Clin. Med. 2025, 14(17), 6152; https://doi.org/10.3390/jcm14176152 - 30 Aug 2025

Cited by 8 | Viewed by 6685

Abstract

Pancreatic pseudocysts (PPCs) are frequent complications of acute and chronic pancreatitis, characterized by encapsulated collections of pancreatic fluid. Historically managed by open surgical approaches, treatment paradigms have significantly evolved with advancements in imaging and minimally invasive techniques. This review outlines the historical progression and current standards in PPC management, covering conservative, surgical, laparoscopic, and endoscopic interventions. Conservative management remains a valid first-line option for asymptomatic, stable pseudocysts, particularly in the absence of complications. Surgical techniques, once the mainstay, such as marsupialization and internal drainage procedures (cystogastrostomy, cystojejunostomy, and cystoduodenostomy), now serve as alternatives when less invasive methods fail. Laparoscopic approaches offer reduced morbidity and faster recovery, especially for complex or inaccessible PPCs. However, endoscopic drainage, particularly endoscopic ultrasound-guided transmural drainage using plastic or metal stents—especially lumen-apposing metal stents (LAMSs)—has become the preferred modality due to its efficacy, safety profile, and cost effectiveness. Emerging technologies, including robotic-assisted surgery and hybrid techniques, promise further refinement in PPC management. This review synthesizes current evidence and expert guidelines, providing a comprehensive overview of evolving strategies and future directions in the treatment of PPCs. Full article

(This article belongs to the Special Issue Acute Pancreatitis and Its Complications: Current Diagnostics and Management)

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Other

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16 pages, 1312 KB

Open AccessSystematic Review

Impact of Acute Pancreatitis Aetiology on Long-Term Outcomes Following a First Episode of Acute Pancreatitis: A Systematic Review and Meta-Analysis

by Emmanuel Malesela Ndaba, Jones A. O. Omoshoro-Jones, Ekene Emmanuel Nweke and Pascaline N. Fru

J. Clin. Med. 2026, 15(9), 3388; https://doi.org/10.3390/jcm15093388 - 29 Apr 2026

Viewed by 626

Abstract

Background: Acute pancreatitis (AP) is increasingly recognised as a disease with clinically significant long-term consequences. However, the extent to which aetiology influences the spectrum of long-term pancreatic sequelae remains unclear. This systematic review and meta-analysis evaluated long-term complications following a first episode of AP, with a protocol-defined focus on the impact of aetiology. Methods: This review evaluated eligible studies that included adults with a first episode of AP who were followed for chronic pancreatitis (CP), exocrine pancreatic insufficiency (EPI), or new-onset diabetes mellitus (NODM). A comprehensive search of PubMed, Scopus, Web of Science, and CENTRAL was conducted from January 2002 to June 2025. Risk of bias was assessed using the Newcastle–Ottawa Scale. Random-effects meta-analyses were performed to estimate pooled incidence proportions. A prespecified network meta-analysis was not feasible because outcome-specific event counts stratified by aetiology were inconsistently reported. This study satisfied PRISMA 2020 guidelines and was registered with PROSPERO (CRD420251074032). Results: Eight studies met eligibility criteria with extractable data for quantitative synthesis. Five studies (n ≈ 10,780) reported chronic pancreatitis (CP), with a pooled incidence of approximately 7–8% following a first episode of acute pancreatitis (AP) and substantial heterogeneity (I² ≈ 96%). Three studies (n = 796) reported exocrine pancreatic insufficiency (EPI), with a pooled incidence of approximately 23%, although estimates were highly heterogeneous (I² ≈ 98%). Four studies (n = 2706; 415 events) reported new-onset diabetes mellitus (NODM), with a pooled incidence of approximately 20% (I² ≈ 93%). Although aetiology-specific quantitative comparisons were not possible, narrative synthesis consistently demonstrated higher long-term risk following alcohol-associated AP, lower risk after biliary AP, and intermediate but variable outcomes in idiopathic AP. Conclusions: Clinically meaningful long-term pancreatic dysfunction is common after a first episode of acute pancreatitis, particularly new-onset diabetes mellitus. While aetiology-specific risks could not be quantified, consistent patterns suggest that aetiology shapes long-term outcomes. These findings support structured, aetiology-informed follow-up after acute pancreatitis and the need for standardised outcome reporting in future studies. Full article

(This article belongs to the Special Issue Acute Pancreatitis and Its Complications: Current Diagnostics and Management)

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