Preferred designs, outcomes, and analysis strategies for treatment trials in idiopathic recurrent acute pancreatitis

摘要

Approximately 80% of acute pancreatitis is caused by alcohol or gallstones, but there remains a significant proportion of these patients who do not have an apparent etiology. Although noninvasive imaging has improved for the biliary tree, including the gallbladder, and for pancre-atic-ductal anatomy, research is still required to see if acting on the abnormalities detected on these tests (such as pancreas divisum or occult microlithiasis) actually improves outcomes. In addition, although some literature exists that supports minor papilla therapy for divisum, sphincterotomy for sphincter of Oddi dysfunction (SOD), and ursodeoxycholic acid and/or sphincterotomy and/or cholecystectomy for gallbladder crystals or sludge, follow-up is variable, cointerventions interfere with interpretation, and skeptics, who call for more data on thera-pies, which, in themselves, carry significant risks (including more pancreatitis), exist. Also, there remain specific questions regarding the role'for "empiric" cholecystectomy (when gallbladder imaging is normal), sphincter manometry, and dual sphincterotomies in those patients with pancreatic sphincter hypertension among other important questions.