Secondary prevention

The most important aspect of prevention is patient education. Eating a balanced, low-fat diet, maintaining adequate triacylglyceride control, and decreasing the amount of alcohol intake, preferably to zero, may help to decrease the incidence of recurrent acute pancreatitis. Data now highlight the substantial correlation between cigarette smoking and recurrent acute pancreatitis. Therefore, patients should be strongly encouraged to abstain completely from tobacco use.

Effectively addressing gallstone disease by any means available (such as cholecystectomy, endoscopic retrograde cholangiopancreatography [ERCP], ursodeoxycholic acid), may decrease ductal obstruction risk and hence the risk of pancreatitis. In patients with hypertriglyceridaemia, statin use has been associated with a decreased risk of developing pancreatitis.[180] Other risk factors may be controlled through patient education and medicine dose adjustments.[181][182]

The use of a peri-ERCP non-steroidal anti-inflammatory agent, such as rectal indomethacin, has been established as a standard of care in decreasing the risk of severe acute post-ERCP pancreatitis.[31][32][33][34] The judicious use of pancreatic duct stents in selected patients is effective in reducing severe pancreatitis following ERCP.[18][31]

The use of pancreatic duct guidewire, however, appears to increase the risk of post-ERCP pancreatitis compared with other endoscopic techniques.[183] [ Cochrane Clinical Answers logo ] ​​

There is also evidence to show that intravenous hydration with 1 to 3 litres of Ringer’s lactate (Hartmann’s solution) either before, during, or after the procedure can lead to a significant decrease in the incidence of post-ERCP pancreatitis.[35][36][184]

Those with idiopathic chronic pancreatitis, recurrent acute pancreatitis, or a family history of pancreatitis should be considered for genetic testing, especially in the setting of pancreatic cancer. In general, genetic evaluation of patients with a single episode of acute pancreatitis is inappropriate and offers little practical benefit to clinicians managing the condition. Any patients with a strong family history of pancreatic disease should be evaluated at a centre of excellence for potential genetic traits.

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