Gallstone Pancreatitis
Everything in the library about gallstone pancreatitis — built automatically from the recorded discussions that name it
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
Nutritional Management
1 item
Enteral Nutrition in Pancreatitis: 2018 Pediatric Surgery Practice Gap #9
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Drs Todd Ponsky, Alex Casar, Alex Gibbons and Rae Hanke review Practice Gap #9 from 2018, as identified by APSA's Professional Development Committee.
video1:00 · Jun 2019
Evidence & Research
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Enteral Nutritional Support For Pancreatitis: Practice Gap discussion at...
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At the 6th Annual Pediatric Surgery Update Course, Drs Charles Snyder, Craig Lillehei and David Powell discussthe top ten practice gaps of 2018. Here they discuss enteral nutritional support for pancreatitis, focusing on early enteral feedi
video16:15 · Sep 2018
Case-Based Learning
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Case-Based Journal Review: Cholelithiasis 2024
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It is already public knowledge that thousands of articles on different pathologies are published every day and that it is very difficult to follow them.
In this format we bring you a different way of knowing what is the most up-to-date o
podcast18:12 · Jul 2024
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Every expert statement below comes from the recorded discussions, with its speaker and moment.
Enteral Nutrition in Pancreatitis: 2018 Pediatric Surgery Practice Gap #9
Early enteral feedings when not associated with vomiting decrease morbidity, infectious risk, and mortality in pancreatitis
clinicalRay0:17 ↗
Nasogastric feeds are equally as tolerated as nasojejunal feeds in pancreatitis
clinicalRay0:26 ↗
Earlier surgical intervention is recommended for gallstone pancreatitis
guidelineRay0:26 ↗
Traditional teaching was to wait many days for amylase and lipase to normalize and for abdominal pain to resolve before starting feeds in pancreatitis
opinion0:35 ↗
Enteral feeding can be provided even in the presence of infected pancreatic phlegmon
clinical0:49 ↗
Enteral Nutritional Support For Pancreatitis: Practice Gap discussion at...
A restrictive transfusion policy with hemoglobin threshold of 7 (rather than 9 or 10) will have no difference in mortality.
host_summary1:03 ↗
RBC transfusions may confer increased risk of DVT in pediatric patients (not NICU scenario), per JAMA Surgery paper.
host_summaryChuck1:20 ↗
Glutamine and arginine have been tried as amino acid nutritional supplements to stabilize gut mucosa or promote nutrition, but there is not a lot of evidence that they actually work.
clinical3:30 ↗
In adults, evidence strongly recommends early feeding (24 to 48 hours) with enteral feedings for acute pancreatitis.
host_summaryChuck6:16 ↗
The route of enteral feeding (nasogastric vs nasojejunal) does not seem to make any difference in pancreatitis management.
host_summaryChuck6:28 ↗
In adults, enteral feeding in pancreatitis reduces morbidity, infectious complications, and mortality, particularly with severe pancreatitis but even in mild to moderate cases, based on meta-analyses and multiple studies.
host_summaryChuck6:44 ↗
There is no benefit to supplemental administration of specific amino acids (glutamine, arginine) in pancreatitis cases.
host_summaryChuck7:05 ↗
Most studies in children regarding enteral feeding in pancreatitis are fairly small and retrospective, but there is good reason to assume the same beneficial effects would occur as in adults.
clinicalChuck7:17 ↗
The myth from surgical training was that feeding would stimulate hormones and the pancreas, but that is not the case.
clinicalCraig7:28 ↗
Studies specifically tracked pain and lipase levels and found they did not particularly correlate with enteral feeding; feeding did not cause these parameters to increase.
host_summaryChuck8:09 ↗
For gallstone pancreatitis with persistent obstruction, if you have an ERCP endoscopist at your institution, do laparoscopic cholecystectomy first, and if you cannot get the stone out, then remove it by ERCP postoperatively (the adult approach).
clinicalRon9:38 ↗
Transcystic stone extraction techniques include flushing the stone out, pushing it back with a Fogarty catheter, or using a basket.
clinicalRon9:58 ↗
One study showed that operative management of gallstone pancreatitis cut down length of stay by about 2 days compared to waiting for ERCP.
clinicalRon10:30 ↗
If the common bile duct is dilated, the cystic duct is usually dilated, allowing placement of a choledochoscope through the cystic duct to basket the stone.
clinicalRon11:31 ↗
Using a basket with fluoroscopy during intraoperative cholangiogram is successful about 90% of the time for stone extraction.
clinicalMark11:58 ↗
The traditional teaching was to let pancreatitis settle down with an interval before cholecystectomy, but experience shows you probably do not gain with that delay; in fact, if you delay to an intermediate timepoint, you may be in a worse spot.
clinicalCraig12:30 ↗
SAGES is now recommending a paradigm change: even for a stuck stone in gallstone pancreatitis, try laparoscopic cholecystectomy with intraoperative cholangiogram first, then send for ERCP if needed; pre-operative ERCP is falling by the wayside.
host_summary12:54 ↗
By the time ERCP is set up for gallstone pancreatitis, the stone has often already passed, which is why there are so many negative ERCPs.
clinical13:23 ↗
For gallstone pancreatitis after stone passage, cholecystectomy should be performed early in the same hospitalization (within 24-48 hours if clinically improving), even if pancreatitis has not completely resolved.
clinicalChuck13:42 ↗
If cholecystectomy is delayed until a month after gallstone pancreatitis, the pancreatitis can recur.
host_summary14:41 ↗
Literature shows that amylase and lipase are not good predictors of severity of pancreatitis.
host_summaryRon15:18 ↗
There is no advantage of nasojejunal versus nasogastric feeds in pancreatitis unless the patient is vomiting and cannot tolerate nasogastric feeds.
clinicalChuck15:31 ↗
Case-Based Journal Review: Cholelithiasis 2024
Chile has the highest rate of cholelithiasis globally
epidemiologicalJose Campos1:07 ↗
In a multi-center study of 167 early cholecystectomy patients versus 79 delayed, early cholecystectomy had 2% recurrence of pancreatitis compared to 22% in delayed surgery
host_summaryCecilia Gigena3:11 ↗
When cholecystectomy was delayed more than 6 weeks after gallstone pancreatitis, recurrence rate increased to 60%
host_summaryCecilia Gigena3:36 ↗
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