19 Feb American Gastroenterology Society guidelines for clinical management of acute pancreatitis

Abstract:
The guidelines provide recommendations for the management of patients with acute pancreatitis (AP). In the past decade, there have been many new understandings and developments in the diagnosis, etiology, early and late management of the disease. Although the diagnosis of AP is established by clinical symptoms and experimental examination, enhanced CT and / or MRI of pancreas is still needed for patients with unclear diagnosis and no improvement of clinical symptoms. Once resuscitation measures are taken, hemodynamic status assessment should be carried out as soon as necessary. Patients with organ failure, exhaustion and / or systemic inflammatory response syndrome should be sent to intensive care unit or intermediate care as far as possible. In addition to patients with cardiovascular and / or renal complications, all patients should be actively rehydrated. In the first 12-24 hours of active intravenous rehydration is the most effective, after the effect is not obvious. Patients with acute pancreatitis and acute cholangitis should be hospitalized for 24 hours
Endoscopic retrograde cholangiography (ERCP) was performed. For high-risk patients, pancreatic stent and / or postoperative rectal NSAID suppositories can be used to reduce the risk of severe pancreatitis after ERCP. Routine prophylactic antibiotics are not recommended for patients with severe acute pancreatitis and / or aseptic necrosis. For patients with bacterial necrosis, antibiotics can penetrate into the pancreatic necrosis area, play a role in delayed intervention, reduce the incidence and mortality. For mild acute pancreatitis, if there is no nausea and vomiting symptoms, oral food should be taken as early as possible. For severe acute pancreatitis, enteral nutrition is recommended to prevent infectious complications and avoid parenteral nutrition. Asymptomatic pancreatitis, extrapancreatic necrosis and pseudocyst, regardless of size, location and scope, do not need intervention. For the stable patients with infectious necrosis, it is better to postpone the surgical treatment, radiotherapy and endoscopic drainage for 4 weeks, so as to form the capsule wall around the necrosis.