Practice Guidelines in Acute Pancreatitis (original) (raw)
Related papers
Management of severe acute pancreatitis
British Journal of Surgery, 2003
Background:Acute pancreatitis is still associated with significant morbidity and mortality. Current management guidelines are sometimes equivocal, particularly in relation to the surgical treatment of severe disease. This review assesses available investigative and treatment strategies to allow the development of a formalized management approach.Acute pancreatitis is still associated with significant morbidity and mortality. Current management guidelines are sometimes equivocal, particularly in relation to the surgical treatment of severe disease. This review assesses available investigative and treatment strategies to allow the development of a formalized management approach.Methods:A literature review of diagnosis, staging and management of acute pancreatitis was performed.A literature review of diagnosis, staging and management of acute pancreatitis was performed.Results and conclusion:Recent evidence has helped to clarify the roles of computed tomography, endoscopic retrograde cholangiopancreatography, prophylactic antibiotics, enteral feeding and fine-needle aspiration for bacteriology in the management of acute pancreatitis. Despite a relative shortage of prospective randomized trials there has been a significant change in the surgical management of acute pancreatitis over the past 20 years. This change has been away from early aggressive surgical intervention towards more conservative management, except when infected necrosis is confirmed. A formalized approach, with appropriate use of the various non-surgical and surgical options, is feasible in the management of severe acute pancreatitis. Copyright © 2003 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.Recent evidence has helped to clarify the roles of computed tomography, endoscopic retrograde cholangiopancreatography, prophylactic antibiotics, enteral feeding and fine-needle aspiration for bacteriology in the management of acute pancreatitis. Despite a relative shortage of prospective randomized trials there has been a significant change in the surgical management of acute pancreatitis over the past 20 years. This change has been away from early aggressive surgical intervention towards more conservative management, except when infected necrosis is confirmed. A formalized approach, with appropriate use of the various non-surgical and surgical options, is feasible in the management of severe acute pancreatitis. Copyright © 2003 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
Current trends in management of acute pancreatitis: A review
Annals of Gastroenterology and the Digestive System, 2019
The incidence of acute pancreatitis has been increased recently with an important mortality rate. Due to that, an adequate management of this pathology is required. Prognosis scales is a useful tool to adequate the treatment. Treatment is based in fluid resuscitation as well as adequate feeding without delay of enteral feeding. Broad spectrum antibiotics should be provided only if another source of infection is clinically suspected and for treatment of fluid collections and necrosis before percutaneous drainage of infectious zone. Necrotic collections are usually monomicrobial and may be produced by gram-negative rods, enterobacter species, or gram-positive organisms. Fever, leukocytosis, and increasing abdominal pain suggest infection of the necrotic tissue. Diagnosis is confirmed by computered tomography scan, which may reveals air bubbles in the necrotic cavity. If debridement is required, it may be realized via minimally invasive techniques, including percutaneous, endoscopic, laparoscopic, and retroperitoneal approaches. The purpose of this review is to summarize the initial management of acute pancreatitis, especially in the Emergency Department.
Background: There have been substantial improvements in the management of acute pancreatitis since the publication of the International Association of Pancreatology (IAP) treatment guidelines in 2002. A collaboration of the IAP and the American Pancreatic Association (APA) was undertaken to revise these guidelines using an evidence-based approach. Methods: Twelve multidisciplinary review groups performed systematic literature reviews to answer 38 predefined clinical questions. Recommendations were graded using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The review groups presented their recommendations during the 2012 joint IAP/APA meeting. At this one-day, interactive conference, relevant remarks were voiced and overall agreement on each recommendation was quantified using plenary voting. Results: The 38 recommendations covered 12 topics related to the clinical management of acute pancreatitis: A) diagnosis of acute pancreatitis and etiology, B) prognostication/predicting severity, C) imaging, D) fluid therapy, E) intensive care management, F) preventing infectious complications, G) nutritional support, H) biliary tract management, I) indications for intervention in necrotizing pancre-atitis, J) timing of intervention in necrotizing pancreatitis, K) intervention strategies in necrotizing pancreatitis, and L) timing of cholecystectomy. Using the GRADE system, 21 of the 38 (55%) recommendations , were rated as 'strong' and plenary voting revealed 'strong agreement' for 34 (89%) recommendations. Conclusions: The 2012 IAP/APA guidelines provide recommendations concerning key aspects of medical and surgical management of acute pancreatitis based on the currently available evidence. These recommendations should serve as a reference standard for current management and guide future clinical research on acute pancreatitis.
Clinical practice guideline: management of acute pancreatitis
There has been an increase in the incidence of acute pancreatitis reported worldwide. Despite improvements in access to care, imaging and interventional techniques, acute pancreatitis continues to be associated with significant morbidity and mortality. Despite the availability of clinical practice guidelines for the management of acute pancreatitis, recent studies auditing the clinical management of the condition have shown important areas of noncompliance with evidence-based recommendations. This underscores the importance of creating understandable and implementable recommendations for the diagnosis and management of acute pancreatitis. The purpose of the present guideline is to provide evidence-based recommendations for the management of both mild and severe acute pancreatitis as well as the management of complications of acute pancreatitis and of gall stone-induced pancreatitis. Une hausse de l'incidence de pancréatite aiguë a été constatée à l'échelle mondiale. Malgré l'amélioration de l'accès aux soins et aux techniques d'imagerie et d'intervention, la pancréatite aiguë est toujours associée à une morbidité et une mortalité importantes. Bien qu'il existe des guides de pratique clinique pour la prise en charge de la pancréatite aiguë, des études récentes sur la vérification de la prise en charge clinique de cette affection révèlent des lacunes importantes dans la conformité aux recommandations fondées sur des données probantes. Ces résultats mettent en relief l'importance de formuler des recommandations compréhensibles et applicables pour le diagnostic et la prise en charge de la pancréatite aiguë. La présente ligne directrice vise à fournir des recommandations fondées sur des données probantes pour la prise en charge de la pancréatite aiguë, qu'elle soit bénigne ou grave, ainsi que de ses complications et de celles de la pancréatite causée par un calcul biliaire. A cute pancreatitis can range from a mild, self-limiting disease that requires no more than supportive measures to severe disease with life-threatening complications. The most common causes of acute pan crea-titis are gallstones and binge alcohol consumption. 1 There has been an increase in the incidence of acute pancreatitis reported worldwide. Despite improvements in access to care, imaging and interventional techniques, acute pancreati-tis continues to be associated with significant morbidity and mortality. A systematic review of clinical practice guidelines for the management of acute pancreatitis revealed 14 guidelines published between 2004 and 2008 alone. 2 Although these guidelines have significant overlap in their recommendations for diagnosing and managing acute pancreatitis, there is disagreement in some aspects of both the timing and types of interventions that should be used for both mild and severe acute pancreatitis. The availability of new imaging modalities and noninvasive therapies has also changed clinical practice. Finally, despite the availability of guidelines, recent studies auditing clinical management of acute pancreatitis have shown important areas of noncompliance with evidence-based recommendations. 3-9 This underscores the importance of creating understandable and implementable recommendations for the diagnosis and management of acute pancreatitis and emphasizes the need for regular audits of clinical practice within a given hospital to ensure compliance. The purpose of the present guideline is to provide evidence-based recommendations for the management of both mild and severe acute pancreatitis as well as the management of complications of acute pancreatitis and of gall stone-induced pancreatitis.
Treatment strategy for acute pancreatitis
Journal of hepato-biliary-pancreatic sciences, 2010
When a diagnosis of acute pancreatitis (AP) is made, fundamental medical treatment consisting of fasting, intravenous (IV) fluid replacement, and analgesics with a close monitoring of vital signs should be immediately started. In parallel with fundamental medical treatment, assessment of severity based on clinical signs, blood test, urinalysis and imaging tests should be performed to determine the way of treatment for each patient. A repeat evaluation of severity is important since the condition is unstable especially in the early stage of AP. At the time of initial diagnosis, the etiology should be investigated by means of blood test, urinalysis and diagnostic imaging. If a biliary pancreatitis accompanied with acute cholangitis or biliary stasis is diagnosed or suspected, an early endoscopic retrograde cholangiopancreatography with or without endoscopic sphincterotomy (ERCP/ES) is recommended in addition to the fundamental medical treatment. In mild cases, the fundamental medical ...
Management of acute pancreatitis: from surgery to interventional intensive care
Gut, 2005
I n recent years, treatment of severe acute pancreatitis has shifted away from early surgical treatment to aggressive intensive care. While the treatment is conservative in the early phase, surgery might be considered in the later phase of the disease. Surgical debridement is still the ''gold standard'' for treatment of infected pancreatic and peripancreatic necrosis. Advances in radiological imaging, new developments in interventional radiology, and other minimal access interventions have revolutionised the management of many surgical conditions over the past decades. Several interventional therapy regimens, including endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy, fine needle aspiration for bacteriology (FNAB), percutaneous or endoscopic drainage of peripancreatic fluid collections, pseudocysts, and late abscesses, as well as selective angiography and catheter directed embolisation of acute pancreatitis associated bleeding complications have been well established as diagnostic and therapeutic standards in the management of acute pancreatitis. Secondary to recent technical improvements in interventional therapy and minimally invasive surgery, even infected pancreatic necrosis has successfully been treated in selected patients. However, technical feasibility does not obviate sound clinical judgement. We must be cautious in the application of new technologies in the absence of well designed clinical trials. Thus minimally invasive surgery and interventional therapy for infected necrosis should be limited to clinical trials and specific indications in patients who are critically ill and otherwise unfit for conventional surgery.
The management of patients with acute pancreatitis
Based on Atlanta's criteria, acute pancreatitis is classified as:-Edematous acute pancreatitis and necrotic acute pancreatitis. Acute necrotic pancreatitis is developed in 15 to 20% of cases. The pancreatic necrotic infection occurs in the second and third week of illness in 40 to 70% of the patients with acute necrotic pancreatitis. This infection is mainly one of major risk factor which influence in complication rate and mortality. Diagnosis of acute pancreatitis is based on clinical presentation, laboratory findings and radiological examinations. There are a number of prognostic systems for detection of illness severity and patient prognosis with acute pancreatitis, such as: Ranson's criterias, APACHE II system, Glasgow system by Imrie, Baltazar stratification of CT-scan etc. The important thing in patients with acute pancreatitis is identification of pancreatic necrotic infection. Golden standard for necrotic infection identification is aspiration with fine needle "CHIBA" followed by US or CT-scan. The patients with acute pancreatitis can be treated conservatively or surgically. It is widely believed that all patients with infection of pancreatic necrosis need surgical treatment. Now, all scientists agree that surgical intervention has to be delayed as long as possible. The modern way of treatment, in the future has to be focused on a single multimodal therapy, which inhibits inflammatory excessive reaction, meanwhile preserves immunitary competence and antimicrobial defense.