LNSLNS We thank Prof. Nizze for his valuable comments to our article. The Atlanta classification does indeed distinguish between pseudocysts on the basis of the underlying disease (acute or chronic pancreatitis). With regard to the prognosis this makes sense because the rate of regression in pseudocysts is high in acute pancreatitis and practically non-existent in chronic pancreatitis. Therapeutically, however, chronic pseudocysts can be dealt with very easily by means of endoscopic drainage, whereas the treatment of acute pseudocysts is burdened with complications and often includes or even necessitates endoscopic necrosectomy. Pathogenetically and with respect to the morphology on imaging studies or histopathology, the current Atlanta classification is rather less helpful, as Prof. Nizze points out. An upcoming revision of the Atlanta classification is going to address this shortcoming. This guideline will explicitly include morphology, and it is due to be published as an international consensus statement in the coming months. Since a consensus has not yet been reached and appears more difficult than anticipated, we were not able to include the new classification in our recent review article.

Panniculitis—as mentioned by Prof. Nizze—as well as other systemic complications associated with extrapancreatic activity of digestive enzymes occasionally occur in acute pancreatitis and more rarely in chronic pancreatitis. In individual cases, this complication has been observed in association with acinar cell carcinoma. In our experience, the incidence—48 cases reported in the literature to date—is way below 1/1000 cases of pancreatitis. For this reason, we did not include it as a typical complications of chronic pancreatitis in our review article. In addition to treating the underlying morbidity, administration of octreotide (1) results in -inhibition of pancreatic secretion and thus provides a strategy for reducing lytic, extrapancreatic necroses.

DOI: 10.3238/arztebl.2010.00042b

Prof. Dr. med. Markus M. Lerch
Direktor der Klinik für Innere Medizin A
Klinikum der Ernst-Moritz-Arndt-Universität Greifswald
Friedrich-Loeffler-Str. 23A
17475 Greifswald, Germany
gastro@uni-greifswald.de

Conflict of interest statement
The authors of both contributions declare that no conflict of interest exists according to the guidelines of the International Committee of Medical Journal Editors.
1.
García-Romero D, Vanaclocha F: Pancreatic panniculitis. Dermatol Clin 2008; 26(4): 465–70, vi.
2.
Lerch M, Stier A, Wahnschaffe U, Mayerle J: Pancreatic pseudocysts: observation, endoscopic drainage or resection? [Pankreaspseudozysten. Abwarten, endoskopisch drainieren, resezieren?] Dtsch Ärztebl Int 2009; 106(38): 614–21.
1. García-Romero D, Vanaclocha F: Pancreatic panniculitis. Dermatol Clin 2008; 26(4): 465–70, vi.
2. Lerch M, Stier A, Wahnschaffe U, Mayerle J: Pancreatic pseudocysts: observation, endoscopic drainage or resection? [Pankreaspseudozysten. Abwarten, endoskopisch drainieren, resezieren?] Dtsch Ärztebl Int 2009; 106(38): 614–21.