Recurrent Acute Pancreatitis: International State-of-the-Science Conference With Recommendations

Recurrent acute pancreatitis (RAP) is a clinically significant problem globally. The etiology remains unclear in approximately 10% to 15% of patients despite a thorough workup. Data on natural history and efficacy of treatments are limited. We aimed to establish criteria for diagnosis, evaluate the causative factors, and arrive at a consensus on the appropriate workup and management of patients with RAP. The organizing committee was formed, and a set of questions was developed based on the current evidence, controversies, and topics that needed further research. After a vetting process, these topics were assigned to a group of experts from around the world with special interest in RAP. Data were presented as part of a workshop on RAP organized as a part of the annual meeting of the America Pancreatic Association. Pretest and Posttest questions were administered, and the responses were tabulated by the current Grades of Recommendation Assessment, Development and Evaluation system. The consensus guidelines were established in the format of a diagnostic algorithm. Several deficiencies were identified with respect to data on etiology, treatment efficacies, and areas that need immediate research

Cystic Neoplasms of the Pancreas.

Pancreatic cystic neoplasms are uncommon, but are being detected at an increased rate in the current era of sophisticated abdominal imaging. The selection of appropriate treatment depends on the ability to distinguish benign from malignant cysts. The most common clinical mistake is to treat a cystic neoplasm as a benign pseudocyst. The identification of a cyst as a cystic neoplasm should be suspected on clinical grounds, but the differentiation from a benign cyst is often difficult based on clinical features and imaging alone. Analysis of cystic fluid for tumor markers and cytology should be considered, using newer approaches such as endoscopic ultrasound-guided fine needle aspiration (FNA), in those patients in whom this information may guide appropriate therapy. Surgical excision of a cystic pancreatic neoplasm is the treatment of choice in patients fit for surgery. Inappropriate treatment of these lesions as pseudocysts, by radiographic, endoscopic, or surgical drainage, is to be avoided. Resection of the lesion should be seriously considered even in the absence of symptoms, as these lesions have malignant potential and are often curable.