MDCalc

Management of Acute Pancreatitis

Official 2024 guideline from the American College of Gastroenterology.

These guideline summaries are shared for educational purposes only and are not intended to direct patient care. For detail on the specific recommendations and information about the evidence considered by the guideline developer, we encourage you to go to the original guideline statement cited below.

Diagnosis

Imaging
Conditional recommendation
Very low quality evidence
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.
Conditional recommendation
Very low quality evidence
In patients with idiopathic acute pancreatitis, the ACG suggests additional diagnostic evaluation with repeat abdominal ultrasound (US), MRI, and/or endoscopic US.

Management

Initial management
Conditional recommendation
Low quality evidence
The ACG suggests moderately aggressive fluid resuscitation for patients with AP. Additional boluses will be needed if there is evidence of hypovolemia.
Conditional recommendation
Low quality evidence
The ACG suggests using lactated Ringer solution over normal saline for IV resuscitation in AP.
ERCP
Conditional recommendation
Low quality evidence
The ACG suggests medical therapy over early (within 72 hrs) ERCP in acute biliary pancreatitis without cholangitis.
Strong recommendation
Moderate quality evidence
The ACG recommends rectal indomethacin to prevent post-ERCP pancreatitis (PEP) in individuals considered to be at high risk of post-ERCP pancreatitis.
Conditional recommendation
Low quality evidence
The ACG suggests placement of a pancreatic duct stent in patients at high risk for PEP who are receiving rectal indomethacin.
Antibiotics
Conditional recommendation
Very low quality evidence
The ACG suggests against prophylactic antibiotics in patients with severe AP.
Conditional recommendation
Very low quality evidence
The ACG suggests against FNA in patients with suspected infected pancreatic necrosis.
Nutrition
Conditional recommendation
Low quality evidence
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.
Conditional recommendation
Low quality evidence
In patients with mild AP, the ACG suggests initial oral feeding with low-fat solid diet rather than a stepwise liquid to solid approach.
Literature
Original/Primary Reference
Research PaperTenner S, Vege SS, Sheth SG, et al. American College of Gastroenterology Guidelines: Management of Acute Pancreatitis. The American Journal of Gastroenterology 2024;119(3):419.