Treatment of acute pancreatitis requires hospitalization, usually for a few days. There are three aspects of treatment during hospitalization, including:
- Resting the pancreas
- Managing pain
- Maintaining blood volume
In order to allow the pancreas to rest and heal, the patient cannot eat or drink anything for a few days.* In severe cases where the pancreas needs several weeks to rest and heal, the patient may require nasogastric feeding, which involves a special liquid given in a long, thin tube inserted through the nose and throat and into the stomach or small bowel. Intravenous, or IV, fluids and medications are administered to relieve pain and maintain blood volume.
If gallstones are the cause of pancreatitis, surgery may be required to remove the gallbladder. If a bile duct is blocked by a gallstone, a special procedure called endoscopic retrograde cholangiopancreatography, or ERCP, may be used to remove the gallstone. ERCP uses a thin, flexible tube with a tiny camera at the end, called an endoscope, to view the pancreas, gallbladder, and bile ducts. The endoscope is passed through the mouth, throat, and stomach into the small intestine, and a special dye is injected into the pancreatic and bile ducts to help the pancreas, gallbladder, and bile ducts appear on special x-rays. A small cut is made along the end of the duct and a sweeping balloon or small basket is then inserted through the endoscope to remove the gallstone.
In addition to gallstone removal, ERCP can be used for other treatments of pancreatitis, including:
- Sphinctorectomy: Using a small wire on the endoscope, the provider finds the muscle that surrounds the pancreatic duct or bile ducts and makes a tiny cut to enlarge the opening. The duct can also be drained if the provider finds a pseudocyst, which is an accumulation of fluid and tissue debris.
- Stent placement: Using the endoscope, the provider places a tiny plastic or metal tube, called a stent, in the narrowed pancreatic or bile duct to keep it open.
- Balloon dilatation: The provider passes a balloon device through the endoscope to dilate, or stretch, a narrowed duct. A temporary stent may be placed for a few months to keep the duct open.
When the person leaves the hospital, they may be advised not to smoke, drink alcohol, or eat fatty foods.
Chronic pancreatitis may also require hospitalization for pain management, nutritional support, and IV fluid replacement. Nasogastric feeding may be necessary for several weeks if weight loss continues.
If the pancreas doesn't secrete enough digestive enzymes on its own, providers may prescribe synthetic pancreatic enzymes. The enzymes should be taken with every meal to help the person digest food and regain weight.
People with chronic pancreatitis are strongly advised not to smoke or drink alcohol, even if pancreatitis is mild or in the early stages. In addition, because chronic pancreatitis is a risk factor for pancreatic cancer, patients should talk to their providers about screening for cancer and ways to reduce other risk factors.
*In some cases, patients may be re-introduced to food earlier than this.