The American Gastroenterological Association (AGA) has issued a new clinical guideline addressing the initial management of acute pancreatitis during the first 48 to 72 hours of hospital admission, a critical period when treatment decisions can significantly impact the course of disease and duration of hospitalization.
The guidelines were published in the journal Gastroenterology in response to growing evidence which has emerged challenging long-held management practices. The guidelines include ‘strong’ and ‘conditional’ recommendations of “very low,” “low,” or “moderate” quality.
The Strong recommendations (all labeled as having ‘moderate quality’ of evidence) include:
- In patients with acute pancreatitis, early (within 24 hours) oral feeding as tolerated rather than keeping the patient nil per os (NPO) is recommended
- In patients with acute pancreatitis and inability to feed orally, enteral rather than parenteral nutrition is recommended
- In patients with acute biliary pancreatitis, cholecystectomy during the initial admission rather than following discharge is recommended
- In patients with acute alcoholic pancreatitis, brief alcohol intervention during admission is recommended
The Conditional recommendations include the following:
- In patients with acute pancreatitis, the AGA suggests goal-directed therapy for fluid management (very low quality evidence)
- The AGA suggests against the use of hydroxyethyl startch (HES) fluids in acute pancreatitis (very low quality evidence)
- In patients with predicted severe acute pancreatitis and necrotizing pancreatitis, the AGA suggests against the use of prophylactic antibiotics (low quality evidence)
- In patients with acute biliary pancreatitis and no cholangitis, the AGA suggests against the routine use of urgent endoscopic retrograde cholangiopancreatography (ERCP) (low quality evidence)
- In patients with predicted severe or necrotizing pancreatitis requiring enteral tube feeding, the AGA suggests either nasogastric or nasoenteral route (low quality evidence)
The guidelines aim to “reduce practice variation and promote high-quality and high-value care for patients suffering from acute pancreatitis.”
Vege SS, DiMagno MJ, Forsmark CE, Martel M, Barkun AN. Initial medical treatment of acute pancreatitis: American Gastroenterological Association institute technical review [published online February 5, 2018]. Gastroenterology. doi:10.1053/j.gastro.2018.01.031
This article originally appeared on MPR