American college of gastroenterology guideline

Management of acute pancreatitis

Scott Tenner, John Baillie, John DeWitt, Santhi Swaroop Vege

Research output: Contribution to journalArticle

684 Citations (Scopus)

Abstract

This guideline presents recommendations for the management of patients with acute pancreatitis (AP). During the past decade, there have been new understandings and developments in the diagnosis, etiology, and early and late management of the disease. As the diagnosis of AP is most often established by clinical symptoms and laboratory testing, contrast-enhanced computed tomography (CECT) and/or magnetic resonance imaging (MRI) of the pancreas should be reserved for patients in whom the diagnosis is unclear or who fail to improve clinically. Hemodynamic status should be assessed immediately upon presentation and resuscitative measures begun as needed. Patients with organ failure and/or the systemic inflammatory response syndrome (SIRS) should be admitted to an intensive care unit or intermediary care setting whenever possible. Aggressive hydration should be provided to all patients, unless cardiovascular and/or renal comorbidites preclude it. Early aggressive intravenous hydration is most beneficial within the first 12-24 h, and may have little benefit beyond. Patients with AP and concurrent acute cholangitis should undergo endoscopic retrograde cholangiopancreatography (ERCP) within 24 h of admission. Pancreatic duct stents and/or postprocedure rectal nonsteroidal anti-inflammatory drug (NSAID) suppositories should be utilized to lower the risk of severe post-ERCP pancreatitis in high-risk patients. Routine use of prophylactic antibiotics in patients with severe AP and/or sterile necrosis is not recommended. In patients with infected necrosis, antibiotics known to penetrate pancreatic necrosis may be useful in delaying intervention, thus decreasing morbidity and mortality. In mild AP, oral feedings can be started immediately if there is no nausea and vomiting. In severe AP, enteral nutrition is recommended to prevent infectious complications, whereas parenteral nutrition should be avoided. Asymptomatic pancreatic and/or extrapancreatic necrosis and/or pseudocysts do not warrant intervention regardless of size, location, and/or extension. In stable patients with infected necrosis, surgical, radiologic, and/or endoscopic drainage should be delayed, preferably for 4 weeks, to allow the development of a wall around the necrosis.

Original languageEnglish
Pages (from-to)1400-1415
Number of pages16
JournalAmerican Journal of Gastroenterology
Volume108
Issue number9
DOIs
StatePublished - Sep 2013

Fingerprint

Gastroenterology
Pancreatitis
Guidelines
Necrosis
Endoscopic Retrograde Cholangiopancreatography
Anti-Bacterial Agents
Systemic Inflammatory Response Syndrome
Suppositories
Cholangitis
Pancreatic Ducts
Parenteral Nutrition
Enteral Nutrition
Disease Management
Nausea
Vomiting
Stents
Intensive Care Units
Drainage
Pancreas
Anti-Inflammatory Agents

ASJC Scopus subject areas

  • Gastroenterology

Cite this

American college of gastroenterology guideline : Management of acute pancreatitis. / Tenner, Scott; Baillie, John; DeWitt, John; Vege, Santhi Swaroop.

In: American Journal of Gastroenterology, Vol. 108, No. 9, 09.2013, p. 1400-1415.

Research output: Contribution to journalArticle

Tenner, Scott ; Baillie, John ; DeWitt, John ; Vege, Santhi Swaroop. / American college of gastroenterology guideline : Management of acute pancreatitis. In: American Journal of Gastroenterology. 2013 ; Vol. 108, No. 9. pp. 1400-1415.
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