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Interventional and Surgical Treatment of Acute and Chronic Pancreatitis

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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: 25 February 2026 | Viewed by 5756

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Dr. Chirag Desai

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Department of Surgery, Division of Abdominal Transplantation, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
Interests: hepatobiliary and pancreatic surgery; auto islet cell transplantation; liver transplantation; islet cell transplants; advanced liver; bile duct, and pancreatic surgery; chronic pancreatitis

Special Issue Information

Dear Colleagues,

The field of pancreatitis management has seen remarkable progress in recent years, particularly in interventional treatments. Conditions ranging from acute pancreatitis to recurrent acute pancreatitis and the challenging transition to chronic pancreatitis have historically been associated with significant morbidity and mortality. However, advancements in radiological, endoscopic, and surgical approaches have transformed the management of this complex disease, significantly improving patient outcomes and quality of life.

Patients now benefit from a spectrum of treatment options, including percutaneous interventions, endoscopic techniques, laparoscopic and robotic procedures, and various surgical strategies such as drainage procedures, parenchyma-preserving resections, and total pancreatectomy with or without islet autotransplantation. Despite these advancements, there remains a critical need for high-quality data to further refine and optimize treatment strategies. This Special Issue invites original research, reviews, and case series on the interventional management and outcomes of pancreatitis. Submissions may cover a wide range of topics, including but not limited to:

Percutaneous radiological interventions.
Endoscopic techniques for acute and chronic pancreatitis.
Minimally invasive surgical approaches, including laparoscopic and robotic procedures.
Open surgical techniques, such as the Whipple procedure, distal pancreatectomy, or total pancreatectomy with or without islet autotransplant.
Innovations in islet cell transplantation and outcomes after pancreatic surgeries.
Short- and long-term outcome-focused data around these treatment strategies.

We encourage authors to contribute cutting-edge studies and comprehensive reviews that highlight advancements in the field and address the existing gaps in the literature. Join us in advancing the understanding and management of pancreatitis through this Special Issue.

Dr. Chirag Desai
Guest Editor

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Keywords

pancreatitis treatment
endoscopic treatment
pancreatic surgery
Whipple
distal pancreatectomy
islet cell auto trans-plant
total pancreatectomy
TPIAT
laparoscopic treatment of pancreatitis
robotic surgery for pancreatitis

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Published Papers (5 papers)

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Research

Jump to: Review

12 pages, 783 KB

Open AccessFeature PaperArticle

Value of Continuous Hemofiltration in Patients with Severe Acute Pancreatitis at Onset: Single Centre Experience on 48 Patients

by Paolina Saullo, Roberto Caronna, Alberto Maria Angelici, Valerio Rinaldi, Giovanni Liberatori, Andrea Mingoli and Piero Chirletti

J. Clin. Med. 2025, 14(18), 6647; https://doi.org/10.3390/jcm14186647 - 21 Sep 2025

Viewed by 525

Abstract

Background: Severe acute pancreatitis (SAP) presents with Multiple Organ Dysfunction Syndrome (MODS) in ~15% of cases, accounting for ~35% of early deaths within 48 h. Major complications—shock, renal failure, and respiratory insufficiency—arise from an overwhelming systemic inflammatory response driven by markedly elevated pro-inflammatory cytokines. Massive release of IL-2, IL-6, and TNF-α underlies the systemic inflammatory response syndrome (SIRS). Continuous veno-venous hemofiltration (CVVH) with the oXiris filter, adsorbing endotoxins and cytokines, has been used in sepsis and applied early in SAP to reduce cytokine load and organ injury. Aims: To evaluate the efficacy and safety of early CVVH with the oXiris filter in modulating the systemic inflammatory response by removing toxic cytokines from the bloodstream in patients with SAP complicated by organ dysfunction and refractory sepsis. Methods: This single-centre, retrospective, observational study was conducted at a tertiary university hospital between 2000 and 2022. Forty-eight consecutive patients with SAP at onset, defined according to the 2012 Atlanta Classification, with an APACHE II score ≥ 19 and persistent organ dysfunction (>48 h), were included. All patients were unresponsive to initial intensive care within the first 24 h and underwent urgent laparotomy with extensive peritoneal lavage, pancreatic necrosectomy, and placement of multiple abdominal drains, followed by transfer to the intensive care unit. CVVH (Prismax system) with the oXiris filter was initiated within 12 h post-surgery. IL-6 and TNF-α were selected as inflammatory markers and measured in both serum and ultrafiltrate at baseline (0 h) and at 24, 48, 72, and 96 h. These measurements were correlated with clinical parameters and prognostic scores (APACHE II, SOFA). Results: Treatment was well tolerated in all patients. The 28-day survival rate was 97.9%. There was a significant time-dependent decrease in IL-6 (p = 0.019) and TNF-α (p = 0.008) concentrations in the ultrafiltrate, consistent with high early adsorption followed by a reduced cytokine burden, whereas serum levels showed a non-significant downward trend (IL-6 p = 0.08; TNF-α p = 0.310). The APACHE II score decreased from 23 postoperatively to 8 by the second week (−65.2%; p = 0.013), with a statistically significant correlation between cytokine reduction and clinical improvement. Adverse events were rare and manageable. Conclusions: Early CVVH with the oXiris filter in SAP, complicated by MODS and refractory sepsis, proved safe, well-tolerated, and potentially effective in reducing cytokine burden and improving prognostic indices. These findings support the hypothesis of a relevant immunomodulatory effect, warranting prospective controlled trials to confirm its true impact on survival and organ recovery. Full article

(This article belongs to the Special Issue Interventional and Surgical Treatment of Acute and Chronic Pancreatitis)

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13 pages, 217 KB

Open AccessArticle

Pancreatogenic Type 3c Diabetes After Major Pancreatic Resections for Chronic Pancreatitis: A Single-Center Experience of More than 100 Surgical Cases

by Dhruv J. Patel, Alexandra D. Nelson, Melissa E. Chen, Morgan S. Jones and Chirag S. Desai

J. Clin. Med. 2025, 14(16), 5817; https://doi.org/10.3390/jcm14165817 - 17 Aug 2025

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Abstract

Background/Objectives: The impact of surgical resection for chronic pancreatitis on subsequent endocrine outcomes remains unclear. Methods: A single-center analysis of patients with chronic pancreatitis who underwent either a parenchymal-preserving surgery (PPS) or a total pancreatectomy (TP) with/without islet autotransplantation (IAT) between 2018 and 2024 was performed. Preoperative and postoperative changes in hemoglobin A1C (HbA1C) and long-acting insulin dose were compared. Univariate and multivariate analysis was performed to identify factors associated with 1-year insulin independence. Results: A total of 104 patients underwent surgery for chronic pancreatitis between 2018 and 2024. A total of 35 (33.7%) patients underwent TPIAT, 8 (7.7%) underwent TP, and 61 (58.7%) underwent PPS (n = 18 Whipple, n = 38 distal pancreatectomy, n = 5 drainage procedure). Median HbA1C increased after surgery (5.7% vs. 6.8%, p < 0.001). The majority of patients (n = 73, 70.2%) were discharged postoperatively without any basal insulin requirement. Of the 31 patients discharged on basal insulin, 18 patients (58.1%) were not on basal insulin preoperatively; the other 13 patients (41.9%) that were on basal insulin preoperatively had a median change in their postoperative basal insulin dose of −5 units [IQR: −12–−1]. A total of 46 patients (52.3%) were insulin independent at one year, with PPS more favorable than TPIAT (47.6% vs. 21.7%, p < 0.001) and less likely to have been on preoperative basal insulin. Conclusions: Surgery for chronic pancreatitis resulted in an increase in HbA1C postoperatively; however, diabetes remained well-controlled as the majority of patients remained off basal insulin at one year from surgery. PPS patients were more likely to be insulin-independent. Full article

(This article belongs to the Special Issue Interventional and Surgical Treatment of Acute and Chronic Pancreatitis)

14 pages, 4372 KB

Open AccessArticle

Association of Visceral Adiposity and Sarcopenia with Geospatial Analysis and Outcomes in Acute Pancreatitis

by Ankit Chhoda, Manisha Bohara, Anabel Liyen Cartelle, Matthew Antony Manoj, Marco A. Noriega, Miriam Olivares, Jill Kelly, Olga Brook, Steven D. Freedman, Abraham F. Bezuidenhout and Sunil G. Sheth

J. Clin. Med. 2025, 14(9), 3005; https://doi.org/10.3390/jcm14093005 - 26 Apr 2025

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Background: Radiological imaging has improved our insight into how obesity and sarcopenia impacts acute pancreatitis via several measured variables. However, we lack understanding of the association between social determinants of health and these variables within the acute pancreatitis population. Methods: This study included patients at a single tertiary care center between 1 January 2008 and 31 December 2021. Measurements of visceral adiposity (VA), subcutaneous adiposity (SA), the ratio of visceral to total adiposity (VA/TA), and degree of sarcopenia via psoas muscle Hounsfield unit average calculation (HUAC) were obtained on CT scans performed at presentation. Using geocoded patient data, we calculated the social vulnerability index (SVI) from CDC metrics. Descriptive and regression analyses were performed utilizing clinical and radiological data. Results: In 484 patients with 592 acute pancreatitis-related hospitalization, median (IQR) VA was 176 (100–251), SA was 209.5 (138.5–307), VA/TA ratio was 43.5 (32.3–55.3), and HUAC was 51.3 (44.4–58.9). For our primary outcome, geospatial analyses showed a reverse association between VA and SVI with a coefficient of −9.0 (p = 0.04) after adjustment for age, health care behaviors (i.e., active smoking and drinking), and CCI, suggesting residence in areas with higher SVI is linked to lower VA. However, VA/TA, SA, and HUAC showed no significant association with SVI. The SVI subdomain of socioeconomic status had significant association with VA (−39.78 (95% CI: −75.88–−3.70), p = 0.03) after adjustments. For our secondary outcome, acute pancreatitis severity had significant association with higher VA (p ≤ 0.001), VA/TA (p ≤ 0.001), and lower HUAC (p ≤ 0.001). When comparing single vs. recurrent hospitalization patients, there was significantly higher median VA with recurrences (VA-single acute pancreatitis: 149 (77.4–233) vs. VA-recurrent acute pancreatitis: 177 (108–256); p = 0.04). Conclusions: In this study we found that patients residing in more socially vulnerable areas had lower visceral adiposity. This paradoxical result potentially conferred a protective effect against severe and recurrent acute pancreatitis; however, this was not found to be statistically significant. Full article

(This article belongs to the Special Issue Interventional and Surgical Treatment of Acute and Chronic Pancreatitis)

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Review

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35 pages, 2419 KB

Open AccessReview

Clinical, Radiological, and Endoscopic Features of Pancreatic Pseudocyst and Walled-Off Necrosis: How to Diagnose and How to Drain Them

by Giuseppe Dell’Anna, Salvatore Lavalle, Paolo Biamonte, Jacopo Fanizza, Edoardo Masiello, Angelo Bruni, Francesco Vito Mandarino, Paoletta Preatoni, Francesco Azzolini, Jahnvi Dhar, Jayanta Samanta, Antonio Facciorusso, Elisa Stasi, Mattia Brigida, Armando Dell’Anna, Marcello Spampinato, Marcello Maida, Sara Massironi, Vito Annese, Lorenzo Fuccio, Gianfranco Donatelli and Silvio Danese Show full author list Hide full author list

J. Clin. Med. 2025, 14(21), 7818; https://doi.org/10.3390/jcm14217818 - 3 Nov 2025

Viewed by 314

Abstract

Pancreatic pseudocysts (PPs) and walled-off necrosis (WON) are two distinct sequelae of acute and chronic pancreatitis, requiring accurate differentiation to guide appropriate management. Computed tomography (CT) and magnetic resonance imaging (MRI) remain essential for distinguishing PPs from WON, assessing their content, and identifying potential complications. Endoscopic ultrasound (EUS) has emerged as a key modality for both diagnosis and drainage planning, offering high-resolution imaging and the possibility of real-time aspiration. Management strategies have evolved significantly, shifting from surgical to minimally invasive approaches. Endoscopic drainage, including EUS-guided transmural drainage with double-pigtail or lumen-apposing metal stents (LAMS), has become the preferred strategy for symptomatic or infected collections. Endoscopic necrosectomy is increasingly performed for WON, providing a less invasive alternative to surgical debridement. However, patient selection and procedural techniques remain topics of ongoing debate. The aim of this review is to provide a comprehensive synthesis of current evidence regarding the diagnosis and management of pancreatic pseudocyst and walled-off necrosis. We will synthesize current evidence on diagnostic criteria, imaging modalities, and therapeutic algorithms for PPs and WON. We will discuss technical aspects, success rates, and complications associated with drainage modalities, comparing endoscopic, percutaneous, and surgical approaches. Special attention will be given to recent advancements in interventional endoscopy and their impact on patient outcomes. By integrating clinical insights with the latest literature, this review aims to provide an up-to-date reference for clinicians managing pancreatic fluid collections. A literature search was performed using PubMed, Scopus, Web of Science, and MEDLINE databases to identify relevant studies on diagnostic criteria, imaging techniques, and management strategies. Full article

(This article belongs to the Special Issue Interventional and Surgical Treatment of Acute and Chronic Pancreatitis)

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19 pages, 2611 KB

Open AccessEditor’s ChoiceReview

Interventional Management of Acute Pancreatitis and Its Complications

by Muaaz Masood, Amar Vedamurthy, Rajesh Krishnamoorthi, Shayan Irani, Mehran Fotoohi and Richard Kozarek

J. Clin. Med. 2025, 14(18), 6683; https://doi.org/10.3390/jcm14186683 - 22 Sep 2025

Viewed by 2479

Abstract

Acute pancreatitis (AP) is the most common cause of gastrointestinal-related hospitalizations in the United States, with gallstone disease and alcohol as the leading etiologies. Management is determined by disease severity, classified as interstitial edematous pancreatitis or necrotizing pancreatitis, with severity further stratified based on local complications and systemic organ dysfunction. Regardless of etiology, initial treatment involves aggressive intravenous fluid resuscitation with Lactated Ringer’s solution, pain and nausea control, early oral feeding in 24 to 48 h, and etiology-directed interventions when indicated. In gallstone pancreatitis, early endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy is indicated in the presence of concomitant cholangitis or persistent biliary obstruction, with subsequent laparoscopic cholecystectomy as standard of care for stone clearance. The role of interventional therapy in uncomplicated AP is limited in the acute phase, except for biliary decompression or enteral feeding support with nasojejunal tube placement. However, in severe AP with complications, interventional radiology (IR) and endoscopic approaches play a pivotal role. IR facilitates early percutaneous drainage of symptomatic, acute fluid collections and infected necrosis, particularly in non-endoscopically accessible retroperitoneal or dependent collections, improving outcomes with a step-up approach. IR-guided angiographic embolization is the preferred modality for hemorrhagic complications, including pseudoaneurysms. In the delayed phase, walled-off necrosis (WON) and pancreatic pseudocysts are managed with endoscopic ultrasound (EUS)-guided drainage, with direct endoscopic necrosectomy (DEN) reserved for infected necrosis. Dual-modality drainage (DMD), combining percutaneous and endoscopic drainage, is increasingly utilized in extensive or complex collections, reflecting a collaborative effort between gastroenterology and interventional radiology comparable to that which exists between IR and surgery in institutions that perform video assisted retroperitoneal debridement (VARD). Peripancreatic fluid collections may fistulize into adjacent structures, including the stomach, small intestine, or colon, requiring transpapillary stenting with or without additional closure of the gut leak with over-the-scope clips (OTSC) or suturing devices. Additionally, endoscopic management of pancreatic duct disruptions with transpapillary or transmural stenting plays a key role in cases of disconnected pancreatic duct syndrome (DPDS). Comparative outcomes across interventional techniques—including retroperitoneal, laparoscopic, open surgery, and endoscopic drainage—highlight a shift toward minimally invasive approaches, with decreased morbidity and reduced hospital stay. The integration of endoscopic and interventional radiology-guided techniques has transformed the management of AP complications and multidisciplinary collaboration is essential for optimal patient outcomes. Full article

(This article belongs to the Special Issue Interventional and Surgical Treatment of Acute and Chronic Pancreatitis)

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