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Open research questions in Pancreatitis Pathology and Treatment

35 unresolved questions extracted from the limitations and future-work sections of 390 Pancreatitis Pathology and Treatment papers in our library. Each links back to the study that raised it.

What the literature leaves open

  • 447 World Journal of Advanced Research and Reviews, 2026, 30(03), 443-449 Our study provides valuable regional data regarding prognostic assessment of acute pancreatitis in North African populations, where published evidence remains limited.

    Prognostic Value of BISAP Score Combined with 48-Hour C-Reactive Protein for Early Prediction of Severe Acute Pancreatitis: A Retrospective Single-Center Study · 2026 · DOI

  • Although CPAP and NIV are frequently used to improve oxygenation in acute hypoxemic respiratory failure, their application after upper gastrointestinal surgery remains controversial because positive airway pressure may increase intragastric pressure and potentially compromise fresh gastrointestinal anastomoses (4).

    High-Flow Nasal Oxygen for ARDS Secondary to Postoperative Pancreatic Fistula After Pancreaticoduodenectomy: A Case Report. · 2026 · DOI

  • Key Words: Pancreatic inflammation; Genetic variants; Children; Genotype-phenotype correlation; Radiologic findings Core Tip: Although genetic factors constitute a major component of the etiology of pediatric chronic pancreatitis, radiologic phenotypic differences among genetic subtypes remain poorly characterized. Clinical and radiological profiles of pediatric CP stratified by gene and variant remain poorly characterized in the literature.

    Genetically influenced pediatric chronic pancreatitis: Radiologic perspectives · 2026 · DOI

  • Only limited data have addressed the relationship between persistent elevation of pancreatic enzymes beyond the early phase of AP and subsequent infection of fluid collections.

    Persistent pancreatic enzyme elevation is correlated with superinfection in acute pancreatitis with fluid collections: a prospective, multicentre cohort analysis · 2026 · DOI

  • Therefore, current evidence is insufficient to establish the clinical superiority of any specific triglyceride-lowering strategy in HTG-AP. Although some randomized evidence suggests that therapeutic plasma exchange may achieve faster biochemical triglyceride reduction, the available evidence remains insufficient to confirm a meaningful improvement in patient-centered outcomes.

    Comparative Efficacy of Insulin and Alternative Therapies for Hypertriglyceridemia-Associated Acute Pancreatitis: A Systematic Review and Network Meta-Analysis · 2026 · DOI

  • This proportion represents a potential source of selection bias, particularly for out- comes supported by sparse evidence, including CRP, 48-h triglyceride levels, and organ failure. Overall, although this NMA offers a broad comparative synthesis of available evidence, the certainty of evidence remains limited.

    Comparative Efficacy of Insulin and Alternative Therapies for Hypertriglyceridemia-Associated Acute Pancreatitis: A Systematic Review and Network Meta-Analysis · 2026 · DOI

  • Therefore, residual expo- sure heterogeneity remains an important limitation and may affect reproducibility and external validity. Previous randomized trials of probiotics alone in SAP have shown mixed results on clinical outcomes, with some sug- gesting harm (Besselink et al.

    Associations of probiotics combined with Tongli Gongxia Chinese medicine with intestinal barrier biomarkers and day 7 short-chain fatty acids in patients with severe acute pancreatitis · 2026 · DOI

  • Another limitation of this study is that CRP and other laboratory parameters were evaluat- ed only at the time of hospital admission. Future prospective, multicenter studies are warranted to validate these findings and to explore the prognostic significance of dynamic changes in these indices throughout the clinical course of AP.

    Prognostic Nutritional Index and CRP/Albumin Ratio in Predicting Acute Pancreatitis Outcomes · 2026 · DOI

  • This case adds to the emerging evidence that IPN can be docu- mented within the first week of SAP in patients with persistent organ failure and sustained intra-abdominal hypertension, though the exact onset remains uncertain.

    Case Report: Early documented infected pancreatic necrosis due to carbapenem-resistant Acinetobacter baumannii and concurrent Enterococcus faecium bacteremia: a salvage regimen with sulbactam-durlobactam and tigecycline · 2026 · DOI

  • Beyond those already discussed, this case has additional limita- tions. First, while IPN was microbiologically confirmed on day 7, the exact onset may have been earlier because peri-pancreatic fluid was not sampled before that time. Second, the favorable outcome with SUL-DUR plus tigecycline cannot be generalized without larger cohorts or randomized trials. Third, no therapeutic drug monitoring was available for SUL-DUR during CRRT; the q8h interval was based on ex vivo modeling (11), and clinical pharmacokinetic studies are urgently needed.

    Case Report: Early documented infected pancreatic necrosis due to carbapenem-resistant Acinetobacter baumannii and concurrent Enterococcus faecium bacteremia: a salvage regimen with sulbactam-durlobactam and tigecycline · 2026 · DOI

  • The coexistence of recurrent arterial bleeding requiring stepwise embolization and subsequent splenic abscess formation represents a complex clinical scenario that illustrates the challenges of therapeutic decision-making in severe pancreatitis and remains insufficiently discussed in the literature.

    Case Report: Delayed complications of endovascular treatment of recurrent erosive hemorrhage in necrotizing pancreatitis · 2026 · DOI

  • • Empirical PERT may be considered, when resuming oral feeding, in extensive necrosis or necrosectomy and in patients with symptoms of maldigestion. • Treatment includes PERT for PEI and standard diabetes therapy for endocrine insufficiency. • Follow‐up is advised at 3, 6, and 12 months, and then every 6–12 months if disfunction persist, through laboratory and clinical monitoring.

    AEG‐AESPANC‐OPGE‐SIED‐SPG Ibero‐Latin American Guidelines on Acute Pancreatitis (iLATAM‐AP) · 2026 · DOI

  • • Minimally invasive surgical necrosectomy is recommended if percutaneous or endo- scopic approaches fail. • Therapeutic anticoagulation may be considered in acute portal vein thrombosis, multi‐vessel splanchnic vein thrombosis, or progressive splenic vein thrombosis. • Thrombophilia testing is recommended post‐acute episode to guide recurrence risk and treatment duration. • Treatment involves LMWH followed by oral anticoagulants for 3–6 months; dis- continue after resolution or absent recana- lization, except in thrombophilia. • Current evidence does not support beta‐ blockers or endoscopic therapy for primary or secondary bleeding prevention in left‐ sided non‐cirrhotic portal hypertension. • In mild AP, laparoscopic cholecystectomy should be performed during the index hospitalization. • In moderately severe to severe cases, cho- lecystectomy should be delayed until 8 weeks post‐discharge or after resolution of local complications. • In mild or predicted severe AP without cholangitis but with persistent cholestasis or duct dilation, testing may be delayed up to 1 week if the patient is clinically stable. If cholestasis resolves and ducts are non‐ dilated, no further testing is needed. • In mild biliary ap with high suspicion choledocholithiasis scheduled for early cholecystectomy, preoperative biliary exploration is advised when one of the following criteria are met: ◦ bilirubin > 70 μmol/L (4 mg/dL) ◦ common bile duct > 6 mm with bilirubin 30–70 μmol/L (1.75–4 mg/dL) ◦ signs of cholangitis. • MRCP or EUS should be used in uncertain cases due to their high accuracy to detect lithiasis. • Assessment of pancreatic function is rec- ommended in patients with necrotizing AP, alcoholic etiology, recurrent forms, patients undergoing necrosectomy or with meta- bolic risk factors. • Fecal elastase is suitable for PEI screening, while endocrine function should be evalu- ated with fasting glucose, HbA1c, and/or C‐ peptide.

    AEG‐AESPANC‐OPGE‐SIED‐SPG Ibero‐Latin American Guidelines on Acute Pancreatitis (iLATAM‐AP) · 2026 · DOI

  • • In patients with choledocholithiasis without acute cholangitis, ERCP can be delayed, as early intervention does not improve outcomes. • IAH is defined as IAP > 12 mmHg; abdominal compartment syndrome is defined as IAP > 20 mmHg with new onset OF. • ICU patients with AP should undergo IAP monitoring; management includes medical measures (sedation, nasogastric and rectal tubes, prokinetics), percutaneous drainage, and even decompressive laparotomy if abdominal compartment syndrome persists. • MRCP is recommended as the first‐line diagnostic modality for suspected DPDS; secretin‐enhanced MRCP is preferable, when available, due to its higher diagnostic sensitivity. Besides, amylase measurement in drained fluid helps detect DPDS. • Endoscopic transluminal drainage is favored over ERCP in complete duct disruption. • Long‐term plastic stent placement is advised in symptomatic cases. • MRCP is recommended before stent removal to assess duct integrity. • Surgical timing in DPDS is unclear; a step‐ up approach is generally preferred, reserving surgery for refractory cases • Contrast‐enhanced CT is effective for diagnosing PPPC, while MRI provides su- perior characterization of their contents when necessary. • Broad‐spectrum antibiotic therapy should be reserved for confirmed or suspected in- fections, with prophylactic use not recommended. • When intervention is required, delaying it for at least 4 weeks is preferred. • Percutaneous drainage is indicated when early drainage (< 4 weeks) is needed, endoscopy or surgery is not feasible, col- lections are inaccessible by other means or as a combination treatment with endo- scopic drainage.

    AEG‐AESPANC‐OPGE‐SIED‐SPG Ibero‐Latin American Guidelines on Acute Pancreatitis (iLATAM‐AP) · 2026 · DOI

  • • AP is a sudden inflammation of the pancreas that can range from mild cases to more severe forms with necrosis and systemic complications, presenting a wide clinical spectrum with significant risk of morbidity and mortality. • Diagnosis of acute pancreatitis requires at least two of three criteria: Typical abdominal pain, elevated serum pancreatic enzymes (more than 3 times the upper limit of normality), or characteristic imaging. • It is mainly a clinical and laboratory diagnosis; imaging is used when presentation is atypical. • Initial assessment includes clinical history, physical examination, liver profile, triglycerides, calcium, and abdominal ultrasound. Contrast‐ enhanced CT is recommended if malignancy is suspected. • If the cause is unclear, follow‐up may include repeat ultrasound, labs, EUS and/ or MRCP; contrast‐ enhanced CT is a secondary option. • Genetic and/or immunological testing may be considered for recurrent idiopathic cases. • Idiopathic AP is defined as AP with no identifiable cause after thorough history, lab workup, and at least one advanced imaging test (EUS and/or MRCP). • RAP is defined as two or more distinct AP episodes, separated by over 3 months of complete resolution. • Diagnosis: Levels > 1000 mg/dL confirm AP cause if no other etiology is found; > 500 mg/dL indicates high likelihood. • Treatment: Lower TG levels rapidly with fasting and insulin; blood purification may be considered if TG > 5000 mg/dL. • Start oral fibrates once feeding resumes. • Severity of acute pancreatitis should be classified using Revised Atlanta Classification, based on OF and local and systemic complications. • For early prediction, BISAP and persistent SIRS are recommended due to their simplicity despite limited accuracy.

    AEG‐AESPANC‐OPGE‐SIED‐SPG Ibero‐Latin American Guidelines on Acute Pancreatitis (iLATAM‐AP) · 2026 · DOI

  • Third, evidence for clinical translation is weak, mostly consisting of animal experiments or small-sample clinical observations, lacking validation data from large-sample, long-term follow-up studies, and lacking an efficacy prediction and evaluation system based on the gut microbiota-SCFAs axis.

    Gut Microbiota-short-chain Fatty Acid Axis: Novel Perspective for Traditional Chinese Medicine Intervention in Acute Pancreatitis · 2026 · DOI

  • The results of this study should be interpreted with regard to its limitations, including its open-label study design and lack of placebo control, which make the results susceptible to a placebo effect given that the primary outcomes were patient-reported. The PERT dose used for initiation of EPI treatment in patients with chronic pancreatitis in real-world practice varies widely, and unfortunately underdosing of PERT is a major issue in real-world practice. The pancrelipase dose of 72,000 lipase units per meal (and 36,000 lipase units per snack) chosen for initiation of EPI treatment in this study is in alignment with the ACG Clinical Guideline for chronic pancreatitis with EPI, is very commonly used in pancreatitis centers, and has been demonstrated to be effective and safe in patients with EPI due to chronic pancreatitis or pancreatic surgery. Additionally, the inclusion and exclusion criteria and specific requirement for moderate to severe EPI symptoms based on the PEI-Q symptom score, limit the generalizability of the results to treatment-naïve/prior undertreated patients with more advanced chronic pancreatitis with EPI. Moreover, the 3-month study duration may not allow us to draw conclusions regarding the long-term persistence of observed benefits of pancrelipase. The inclusion of prior PERT-undertreated patients and absence of restricting patients from taking vitamin supplements also prevented us from fully exploring changes in laboratory nutrition markers in this observational study.

    Pancrelipase Improves Symptoms of Exocrine Pancreatic Insufficiency and Health-Related Quality of Life in a Real-World Population of Patients with Chronic Pancreatitis · 2026 · DOI

  • | Miroslav Vujasinovic2 J. Enrique Dominguez‐Muñoz1 Djuna Cahen4 | Gabriele Capurso5 | Natalya Gubergrits6 | Peter Hegyi7,8,9,10 | Pali Hungin11 | Johann Ockenga12 | Salvatore Paiella13 | Lukas Perkhofer14 Vinciane Rebours15 | Jonas Rosendahl16 | Roberto Salvia13 | Andrea Szentesi8 | Stefanos Bonovas18,19 J.

    European guidelines for the diagnosis and treatment of pancreatic exocrine insufficiency: UEG, EPC, EDS, ESPEN, ESPGHAN, ESDO, and ESPCG evidence‐based recommendations · 2024 · DOI

  • The global pooled incidence of AP averages at 34 cases per 100,000 general population per year with no gender differences, however, geographical variability in incidence remains fairly inadequate due to the limited research performed in this area.

    At a glance: Pancreatitis and Obesity · 2020 · DOI

  • Background Xuesaitong injection has been explored as an off-label adjuvant therapy for acute pancreatitis in China, but its efficacy and safety remain uncertain.

    Comparative efficacy and safety of Xuesaitong injection as adjuvant therapy for acute pancreatitis: a systematic review and meta-analysis · 2026 · DOI

  • Early diagnosis remains challenging and requires close monitoring, as specific guidelines to prevent irreversible renal damage are lacking; early recognition can significantly improve prognosis and quality of life.

    [Exocrine pancreatic insufficiency and hyperoxaluria: a preventable renal complication from gastroenterology]. · 2026

  • Although sarcopenia reflects nutritional status and physiological reserve, its predictive value for disease progression in AP remains unclear.

    Predictive value of sarcopenia-related clinical indices for early disease progression in acute pancreatitis: a multicenter retrospective cohort study · 2026 · DOI

  • ORIGINAL ARTICLE Buket Daldaban Sarıca, Zehra Filiz Karaman, Derya Altay, Duran Arslan Peer review: Externally peer reviewed.

    Genetically influenced pediatric chronic pancreatitis: Radiologic perspectives · 2026 · DOI

  • s with fibrates, omega-3 fatty acids, or emerging GLP-1 receptor agonists are lacking.

    Trimming the Fat: How Olezarsen Is Poised to Transform the Management of Severe Hypertriglyceridemia-Induced Acute Pancreatitis · 2026 · DOI

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35 open questions have been extracted from the limitations and future-work passages of 390 Pancreatitis Pathology and Treatment papers in our library. Each one below links back to the study that raised it, so you can read the original claim in context.

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