From the Research
There are no significant differences in perioperative outcomes despite the observed delay in time to surgery among patients who developed post-ERCP pancreatitis (PEP). While PEP does typically cause delays in surgical timing, these delays do not seem to translate into worse clinical outcomes for patients. Patients with PEP generally experience resolution of their acute inflammatory process before proceeding to surgery, which may explain why the delay doesn't negatively impact surgical outcomes. The body's inflammatory response typically resolves within days with appropriate supportive care including bowel rest, intravenous fluids, and pain management, as suggested by studies on aggressive hydration 1. This allows patients to recover sufficiently before undergoing their planned surgical procedure. It's essential to note that individual patient factors such as severity of pancreatitis, comorbidities, and the specific surgical procedure planned may still influence outcomes in specific cases, but in general, the delay itself does not appear to be associated with poorer perioperative results when proper management of PEP is implemented.
Some key points to consider in the management of PEP include:
- Aggressive hydration has been shown to reduce the incidence of PEP by 56% compared to standard hydration 1
- The use of octreotide has also been studied as a potential preventive measure for PEP, with some evidence suggesting its effectiveness 2
- Nutrition support is an integral part of care among critically ill patients, and protocols such as the Enhanced Protein-Energy Provision via the Enteral Route Feeding Protocol (PEP uP protocol) may be beneficial in improving feeding adequacy 3, 4, 5 However, the primary concern in the context of perioperative outcomes is the management of PEP itself, rather than the specific nutritional or pharmacological interventions used. Proper management of PEP, including aggressive hydration and supportive care, is crucial in minimizing the impact of the delay on perioperative outcomes. By prioritizing the resolution of the acute inflammatory process and ensuring adequate supportive care, patients with PEP can recover sufficiently before undergoing their planned surgical procedure, ultimately leading to improved morbidity, mortality, and quality of life outcomes.