Management of Acute Pancreatitis
Official 2024 guideline from the American College of Gastroenterology.
Diagnosis
Imaging
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.
Conditional recommendation
Very low quality evidence
Management
Initial management
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.
Conditional recommendation
Low quality evidence
ERCP
The ACG suggests medical therapy over early (within 72 hrs) ERCP in acute biliary pancreatitis without cholangitis.
Conditional recommendation
Low 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.
Strong recommendation
Moderate quality evidence
The ACG suggests placement of a pancreatic duct stent in patients at high risk for PEP who are receiving rectal indomethacin.
Conditional recommendation
Low quality evidence
Antibiotics
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.
Conditional recommendation
Very low quality evidence
Nutrition
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.
Conditional recommendation
Low quality evidence
What do the icons mean?
How strong is the ACG's recommendation?
Strong recommendation
Intervention's desirable effects clearly outweigh undesirable effects.Moderate recommendation
Further research likely to impact confidence in estimate of effect.
Conditional recommendation
Uncertainty in tradeoffs between desirable & undesirable effects of intervention.Weak recommendation
Uncertainty in tradeoffs between desirable & undesirable effects of intervention.
High quality evidence
Further research unlikely to change guideline authors' confidence in estimate of effect.
Moderate-high quality evidence
Between high and moderate levels of evidence.
Moderate quality evidence
Further research likely to impact confidence in estimate of effect.Low quality evidence
Further research expected to have important impact in confidence in estimate of effect.Very low quality evidence
Effect is very uncertain.
