2015 Japanese guidelines for the management of acute pancreatitis

Background: the guidelines for the treatment of acute pancreatitis in Japan (hereinafter referred to as the Japanese guidelines) were first published in 2006. In 2008, the health, laboratory and well-being Ministry (MHLW) revised the severity assessment system for acute pancreatitis and was published as a 2010 edition guide. In 2012, with the revision of Atlanta classification standard for acute pancreatitis, the classification of local complications of pancreatitis was revised, and the minimally invasive treatment of local complications of pancreatitis was developed and spread. New evidence was collected and revised in Japanese guidelines.

Methods: the evidence of epidemiology, diagnosis, severity, treatment, post epcp pancreatitis and clinical indicators was evaluated by using the grade of recommendations assessment (development and evaluation) system. For the part that has been classified as unclear, the meta analysis team of the Japanese guide conducted additional meta analysis and included the results into the guide.

Results: 43 suggestions were provided for 39 problems in 17 related fields. The 17 areas are: diagnosis, imaging diagnosis, etiology, severity assessment, transfer index, liquid therapy, nasogastric tube, pain control, preventive antibiotics, protease inhibitors, nutritional support, intensive care, biliary pancreatitis treatment, abdominal septal syndrome treatment, interventional treatment of local complications, pancreatitis and clinical indicators after ERCP (pancreas Guidelines for intensive treatment of inflammation 2015). Meta analysis based on randomized controlled trials was conducted in the following four related fields: (1) the use of preventive antibiotics; (2) prophylactic pancreatic stent implantation to prevent pancreatitis after ERCP; (3) prophylactic use of NSAIDs to prevent pancreatitis after ERCP; (4) abdominal lavage. The results of meta analysis are used to classify the suggestions to extract useful information. In addition, a mobile software was developed to integrate diagnosis, assess severity, and view 2015 guidelines for enhanced treatment of pancreatitis.