MDCalc

Initial Management of Acute Pancreatitis

Based on guidelines from the American Gastroenterological Association.

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.

Treatment

Treatment: Acute Pancreatitis
Conditional recommendation
Very low quality evidence
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.
Strong recommendation
Moderate 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.
Treatment: Severe or Necrotizing Acute Pancreatitis
Conditional recommendation
Low quality evidence
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.
Treatment: Acute Biliary Pancreatitis
Strong recommendation
Moderate quality evidence
In patients with acute biliary pancreatitis, the AGA recommends cholecystectomy during the initial admission rather than after discharge.
Conditional recommendation
Low quality evidence
In patients with acute biliary pancreatitis and no cholangitis, the AGA suggests against the routine use of urgent ERCP.
Treatment: Acute Alcoholic Pancreatitis
Strong recommendation
Moderate quality evidence
In patients with acute alcoholic pancreatitis, the AGA recommends brief alcohol intervention during admission.
Literature
Original/Primary Reference
Research PaperCrockett SD, Wani S, Gardner TB, et al. American gastroenterological association institute guideline on initial management of acute pancreatitis. Gastroenterology. 2018;154(4):1096-1101.