{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,15]],"date-time":"2025-08-15T01:09:38Z","timestamp":1755220178938,"version":"3.43.0"},"reference-count":24,"publisher":"Georg Thieme Verlag KG","issue":"17","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Dtsch Med Wochenschr"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>Was ist neu?<\/jats:title><jats:p>Die Diagnose der akuten Pankreatitis (AP) ist auch ohne Serum-Amylase m\u00f6glich.<\/jats:p><jats:p>Bei Hypertriglyzerid\u00e4mie bietet Plasmapherese keinen sicheren Vorteil.<\/jats:p><jats:p>Die (Endo-)Sonografie ist obligat. Eine CT soll nicht erfolgen, wenn bereits \u2154 der Diagnosekriterien erf\u00fcllt sind. Eine CT zum Nachweis von Nekrosen ist erst nach 7 Tagen, fr\u00fchestens jedoch nach 72h, sinnvoll.<\/jats:p><jats:p>BISAP, Ranson-Score und Einzelparameter (H\u00e4matokrit, Laktat, BUN) sind unzureichend in der Lage, eine schwere\/nekrotisierende AP vorherzusagen.<\/jats:p><jats:p>Die revidierte Atlanta-Klassifikation k\u00f6nnte der \u201eDeterminant-based Classification\u201c \u00fcberlegen sein.<\/jats:p><jats:p>Nur bei (begleitender) Cholangitis ist eine Notfall-ERC (&lt;24h) indiziert. Ohne Cholangitis ist auch bei bili\u00e4rer Obstruktion eine ERC nicht dringlich (innerhalb von 72h) n\u00f6tig, sollte aber inkl. Papillotomie im station\u00e4ren Aufenthalt erfolgen. Die Implantation eines Pankreas-Stents mindert das Risiko einer Post-ERCP-Pankreatitis.<\/jats:p><jats:p>Bei milder bili\u00e4rer AP soll eine Cholezystektomie noch im Aufenthalt erfolgen.<\/jats:p><jats:p>Die fr\u00fche Volumengabe sorgt f\u00fcr eine bessere Organperfusion. Die ungesteuerte Volumengabe in den ersten 24h ist jedoch \u00fcberholt; Volumenmengen &gt;3ml\/kgKG\/h in den ersten 24h sollten vermieden werden. Mittel der Wahl ist die zielgerichtete Gabe von Voll-Elektrolytl\u00f6sungen (Kontrolle durch Laborparameter, Sonografie, TTE, Pulskontur-Analyse).<\/jats:p><jats:p>Opiate sind NSAID \u00fcberlegen und das Mittel der Wahl.<\/jats:p><jats:p>Eine orale\/enterale Ern\u00e4hrung reduziert das Risiko infizierter Nekrosen und sollte in Abwesenheit eines Schocks innerhalb von 24h begonnen werden. Sie ist parenteraler Ern\u00e4hrung vorzuziehen.<\/jats:p><jats:p>Der Nutzen einer antiinfektiven Prophylaxe ist nicht belegt, selbst bei nekrotisierender AP. Infizierte Nekrosen sind in den ersten 2 Wochen unwahrscheinlich. PCT kann helfen, die sekund\u00e4re antiinfektive Therapie zu steuern.<\/jats:p><jats:p>Nekrosen sollten im minimal-invasiven Step-Up (Antiinfektiva \u2013 Drainage\/Stent \u2013 Nekrosektomie) versorgt werden. Der endoskopische Step-Up hat weniger Komplikationen als der chirurgische. Wo m\u00f6glich, soll erst die Ausbildung einer \u201eWalled-off necrosis\u201c abgewartet und dann direkt nekrosektomiert werden. Der offen chirurgische Ansatz ist obsolet.<\/jats:p><jats:p>Die Behandlung am Zentrum mit erfahrener Intensivstation, interventioneller Endoskopie\/Radiologie und spezialisierter Chirurgie senkt die Mortalit\u00e4t.<\/jats:p>","DOI":"10.1055\/a-2286-0469","type":"journal-article","created":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T22:52:30Z","timestamp":1754607150000},"page":"1027-1033","source":"Crossref","is-referenced-by-count":0,"title":["Akute Pankreatitis: Fortschritt durch Zur\u00fcckhaltung?"],"prefix":"10.1055","volume":"150","author":[{"given":"Jonathan Frederik","family":"Brozat","sequence":"additional","affiliation":[{"name":"Medizinische Klinik mit Schwerpunkt Hepatologie und Gastroenterologie, Charit\u00e9 - Universit\u00e4tsmedizin Berlin, Campi CCM und CVK, Berlin, Deutschland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frank","family":"Tacke","sequence":"additional","affiliation":[{"name":"Medizinische Klinik mit Schwerpunkt Hepatologie 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