Management of Acute Pancreatitis

The ACG suggests transabdominal ultrasound in patients with acute pancreatitis to evaluate for biliary pancreatitis and a repeat ultrasound if the initial examination is inconclusive.

In patients with idiopathic acute pancreatitis, the ACG suggests additional diagnostic evaluation with repeat abdominal ultrasound (US), MRI, and/or endoscopic US.

The ACG suggests moderately aggressive fluid resuscitation for patients with AP. Additional boluses will be needed if there is evidence of hypovolemia.

The ACG suggests using lactated Ringer solution over normal saline for IV resuscitation in AP.

The ACG suggests medical therapy over early (within 72 hrs) ERCP in acute biliary pancreatitis without cholangitis.

The ACG recommends rectal indomethacin to prevent post-ERCP pancreatitis (PEP) in individuals considered to be at high risk of post-ERCP pancreatitis.

The ACG suggests placement of a pancreatic duct stent in patients at high risk for PEP who are receiving rectal indomethacin.

The ACG suggests against prophylactic antibiotics in patients with severe AP.

The ACG suggests against FNA in patients with suspected infected pancreatic necrosis.

In patients with mild AP, the ACG suggests early oral feeding (within 24-48 hrs) as tolerated by the patient compared with the traditional NPO approach.

In patients with mild AP, the ACG suggests initial oral feeding with low-fat solid diet rather than a stepwise liquid to solid approach.