Initial Management of Acute Pancreatitis
Based on guidelines from the American Gastroenterological Association.
Treatment
Treatment: Acute Pancreatitis
In patients with AP, the AGA suggests using goal-directed therapy for fluid management. Note that the AGA makes no recommendation whether normal saline or Ringer’s lactate is used.
Conditional recommendation
Very low quality evidence
In patients with AP, the AGA suggests against the use of hydroxyethyl starch (HES) fluids.
Conditional recommendation
Very low quality evidence
In patients with AP, the AGA recommends early (within 24 h) oral feeding as tolerated, rather than keeping the patient nil per os (npo).
Strong recommendation
Moderate quality evidence
In patients with AP and inability to feed orally, the AGA recommends enteral rather than parenteral nutrition.
Strong recommendation
Moderate quality evidence
Treatment: Severe or Necrotizing Acute Pancreatitis
In patients with predicted severe AP and necrotizing AP, the AGA suggests against the use of prophylactic antibiotics.
Conditional recommendation
Low quality evidence
In patients with predicted severe or necrotizing pancreatitis requiring enteral tube feeding, the AGA suggest either NG or NJ route.
Conditional recommendation
Low quality evidence
Treatment: Acute Biliary Pancreatitis
In patients with acute biliary pancreatitis, the AGA recommends cholecystectomy during the initial admission rather than after discharge.
Strong recommendation
Moderate quality evidence
In patients with acute biliary pancreatitis and no cholangitis, the AGA suggests against the routine use of urgent ERCP.
Conditional recommendation
Low quality evidence
Treatment: Acute Alcoholic Pancreatitis
In patients with acute alcoholic pancreatitis, the AGA recommends brief alcohol intervention during admission.
Strong recommendation
Moderate quality evidence
What do the icons mean?
How strong is the AGA's recommendation?
Strong recommendation
Most individuals in this situation would want the recommended course of action, and only a small proportion would not.Conditional recommendation
The majority of individuals in this situation would want the suggested course of action, but many would not.Moderate quality evidence
We are moderately confident in the effect estimate. The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.Low quality evidence
Our confidence in the effect estimate is limited. The true effect may be substantially different from the estimate of the effect.Very low quality evidence
We have very little confidence in the effect estimate. The true effect is likely to be substantially different from the estimate of effect.Literature
Original/Primary Reference
