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Background and Aims: Although pancreatic endotherapy (PET) is commonly used for treating adverse events of chronic pancreatitis, data on the frequency and factors associated with the use of PET are limited. Our aim was to define the use of and factors predictive for receiving PET in a well-characterized chronic pancreatitis cohort., Methods: This is a cross-sectional analysis of data from PROCEED, a multicenter U.S. cohort study of chronic pancreatitis. PET modalities primarily consisted of ERCP. A treatment course was defined as the number of sessions performed for a specific indication. A repeat course was defined as PET >1 year after completion of the last course. Multivariable logistic regression identified predictive factors for receiving PET, and proportional rates model assessed risk factors for repeat PET., Results: Of 681 subjects, 238 (34.9%) received PET. Factors associated with receiving PET included female sex (odds ratio [OR], 1.26; 95% confidence interval [CI], 1.03-1.53), lower education (OR, 1.30; 95% CI, 1.04-1.62), income ≤$50,000 per year (OR, 1.35; 95% CI, 1.07-1.71), and prior acute pancreatitis (OR, 1.74; 95% CI, 1.31-2.32). Of 238 subjects, 103 (43.3%) underwent repeat PET at a median duration of 2 years, with 23.1% receiving 2 courses, 9.7% receiving 3 courses, and 10.4% receiving ≥4 courses., Conclusions: Nearly half of patients with chronic pancreatitis who undergo PET received 1 or more repeat courses within 2 to 3 years. In addition to a prior history of acute pancreatitis, demographic and socioeconomic factors were associated with receiving PET., Competing Interests: Disclosure The following authors disclosed financial relationships: S. Han, J. J. Easler: Consultant for Boston Scientific. W. G. Park: Research support from AbbVie; advisory board for Nestle, Pfizer, and Ariel Medicine; consultant for Arctx Medical, Olympus, and Capsovision. S. S. Vege: Royalties from UpToDate. D. Yadav: Research support from AbbVie; consultant for Pfizer. All other authors disclosed no financial relationships. Research support for this study was provided by the National Cancer Institute and National Institute of Diabetes and Digestive and Kidney Diseases under award numbers U01DK108288 (Mayo Clinic), U01DK108320 (University of Florida), U01DK108323 (Indiana University), U01DK108326 (Baylor College of Medicine), U01DK108327 (The Ohio State University), U01DK108300 (Stanford University), U01DK108306 (University of Pittsburgh), U01DK108314 (Cedars-Sinai Medical Center), U01DK108328 (University of Texas–MD Anderson Cancer Center), and U01DK108332 (Kaiser Foundation Research Institute)., (Copyright © 2024 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.)

Acute pancreatitis (AP), defined as acute inflammation of the pancreas, is one of the most common diseases of the gastrointestinal tract leading to hospital admission in the United States. It is important for clinicians to appreciate that AP is heterogenous, progressing differently among patients and is often unpredictable. While most patients experience symptoms lasting a few days, almost one-fifth of patients will go on to experience complications, including pancreatic necrosis and/or organ failure, at times requiring prolonged hospitalization, intensive care, and radiologic, surgical, and/or endoscopic intervention. Early management is essential to identify and treat patients with AP to prevent complications. Patients with biliary pancreatitis typically will require surgery to prevent recurrent disease and may need early endoscopic retrograde cholangiopancreatography if the disease is complicated by cholangitis. Nutrition plays an important role in treating patients with AP. The safety of early refeeding and importance in preventing complications from AP are addressed. This guideline will provide an evidence-based practical approach to the management of patients with AP., (Copyright © 2024 by The American College of Gastroenterology.)

Purpose of Review: To summarize recent data on classification systems, cause, risk factors, severity prediction, nutrition, and drug treatment of acute pancreatitis., Recent Findings: Comparison of the Revised Atlanta Classification and Determinant Based Classification has shown heterogeneous results. Simvastatin has a protective effect against acute pancreatitis. Young black male, alcohol, smoldering symptoms, and subsequent diagnosis of chronic pancreatitis are risk factors associated with readmissions after acute pancreatitis. A reliable clinical or laboratory marker or a scoring system to predict severity is lacking. The PYTHON trial has shown that oral feeding with on demand nasoenteric tube feeding after 72 h is as good as nasoenteric tube feeding within 24 h in preventing infections in predicted severe acute pancreatitis. Male sex, multiple organ failure, extent of pancreatic necrosis, and heterogeneous collection are factors associated with failure of percutaneous drainage of pancreatic collections., Summary: The newly proposed classification systems of acute pancreatitis need to be evaluated more critically. New biomarkers are needed for severity prediction. Further well designed studies are required to assess the type of enteral nutritional formulations for acute pancreatitis. The optimal minimally invasive method or combination to debride the necrotic collections is evolving. There is a great need for a drug to treat the disease early on to prevent morbidity and mortality.

Objectives: Symptoms of chronic pancreatitis (CP) frequently hinder patients' ability to work. The aim of our study was to evaluate the impact of CP on employment patterns and health care experience., Methods: Patients with CP at 4 US pancreas centers were evaluated. A survey was given to each patient during an office visit between July 1, 2006 and October 31, 2007., Results: One hundred eleven patient surveys were returned. The median age was 52 years; the median duration of CP symptoms was 8.2 years. Seventy-four percent had their work lives altered by CP, 60% reported an effect on their social lives, and 46% reported an effect on their spouse/significant other relationship (P < 0.03). Only 37% were currently employed. During the week before completing the survey, the patients who were employed reported absences from their job due to CP symptoms, a median of 14 hours. On at least 1 visit to the ED, 80% of respondents reported that they had not been treated with respect and dignity, 45% had been labeled an alcoholic, and 29% had been labeled a drug seeker., Conclusions: Chronic pancreatitis had a profound impact on employment patterns. Comprehensive efforts are needed to improve the health care experience of patients with this disease.