American College of Gastroenterology guideline: management of acute pancreatitis

Tenner, Scott; Baillie, John; DeWitt, John; Vege, Santhi Swaroop

doi:10.1038/ajg.2013.218

Cited by 2,327Pancreatitis Pathology and TreatmentGallbladder and Bile Duct DisordersSepsis Diagnosis and Treatment

American College of Gastroenterology guideline: management of acute pancreatitis

Tenner, Scott, Baillie, John, DeWitt, John, Vege, Santhi Swaroop·2013·American Journal of Gastroenterology

DOI 10.1038/ajg.2013.218

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Abstract

This guideline presents recommendations for the management of patients with acute pancreatitis (AP). During the past decade, there have been new understandings and developments in the diagnosis, etiology, and early and late management of the disease. As the diagnosis of AP is most often established by clinical symptoms and laboratory testing, contrast-enhanced computed tomography (CECT) and/or magnetic resonance imaging (MRI) of the pancreas should be reserved for patients in whom the diagnosis is unclear or who fail to improve clinically. Hemodynamic status should be assessed immediately upon presentation and resuscitative measures begun as needed. Patients with organ failure and/or the systemic inflammatory response syndrome (SIRS) should be admitted to an intensive care unit or intermediary care setting whenever possible. Aggressive hydration should be provided to all patients, unless cardiovascular and/or renal comorbidites preclude it. Early aggressive intravenous hydration is most beneficial within the first 12-24 h, and may have little benefit beyond. Patients with AP and concurrent acute cholangitis should undergo endoscopic retrograde cholangiopancreatography (ERCP) within 24 h of admission. Pancreatic duct stents and/or postprocedure rectal nonsteroidal anti-inflammatory drug (NSAID) suppositories should be utilized to lower the risk of severe post-ERCP pancreatitis in high-risk patients. Routine use of prophylactic antibiotics in patients with severe AP and/or sterile necrosis is not recommended. In patients with infected necrosis, antibiotics known to penetrate pancreatic necrosis may be useful in delaying intervention, thus decreasing morbidity and mortality. In mild AP, oral feedings can be started immediately if there is no nausea and vomiting. In severe AP, enteral nutrition is recommended to prevent infectious complications, whereas parenteral nutrition should be avoided. Asymptomatic pancreatic and/or extrapancreatic necrosis and/or pseudocysts do not warrant intervention regardless of size, location, and/or extension. In stable patients with infected necrosis, surgical, radiologic, and/or endoscopic drainage should be delayed, preferably for 4 weeks, to allow the development of a wall around the necrosis.

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In patients with moderate to severe acute pancreatitis, enteral nutrition is beneficial and early oral feeding with hospital food is not recommended if there is hemodynamic instability.
“EN is beneficial and early oral feeding with hospital food is not recommended”
From ESPEN guideline on hospital nutrition (2021) · cites this paper as [205]
During attacks of acute pancreatitis, early aggressive IV hydration with 250 to 500 mL/h may prevent intravascular volume depletion and pancreatic necrosis.
“During attacks of acute pancreatitis, early aggressive IV hydration with 250 to 500 mL/h may prevent intravascular volume depletion and pancreatic necrosis.50,51”
From Familial chylomicronemia syndrome: Bringing to life dietary recommendations throughout the life span (2018) · cites this paper as [50]

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Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus
Banks, P. A., Bollen, T. L., Dervenis, C., Gooszen, H. G., Johnson, C. D., Sarr, M. G., Tsiotos, G. G., & Vege, S. S. (2013) · Gut · doi:10.1136/gutjnl-2012-302779 · Cited by 7,187 · see citing works
Self-citation
Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.)
McClave, S. A., Taylor, B. E., Martindale, R. G., Warren, M. M., Johnson, D. R., Braunschweig, C., McCarthy, M. S., Davanos, E., Rice, T. W., Cresci, G. A., et al. (2016) · Journal of Parenteral and Enteral Nutrition · doi:10.1177/0148607115621863 · Cited by 3,982 · see citing works
“Severe acute pancreatitis is defined by persistent organ failure lasting >48 hours from admission.(332) Previous scoring systems also used the presence of unfavorable prognostic signs (APACHE II score ≥8 [Acute Physiology and Chronic Health Assessment II], Ranson criteria >3, and CRP level >150 mg/L) to identify patie…”
BackgroundInfluential
Acute pancreatitis
Lankisch, P. G., Apte, M. V., & Banks, P. A. (2015) · The Lancet · doi:10.1016/s0140-6736(14)60649-8 · Cited by 1,216 · see citing works
Acute pancreatitis
Boxhoorn, L., Voermans, R. P., Bouwense, S. A. W., Bruno, M. J., Verdonk, R. C., Boermeester, M. A., van Santvoort, H. C., & Besselink, M. G. (2020) · The Lancet · doi:10.1016/s0140-6736(20)31310-6 · Cited by 1,111 · see citing works
2019 WSES guidelines for the management of severe acute pancreatitis
Leppäniemi, A. K., Tolonen, M., Tarasconi, A., Lohse, H. A. S., Gamberini, E., Kirkpatrick, A. W., Ball, C. G., Parry, N. G., Sartelli, M., Wolbrink, D. R. J., et al. (2019) · World Journal of Emergency Surgery · doi:10.1186/s13017-019-0247-0 · Cited by 1,020 · see citing works
New insights into acute pancreatitis
Lee, P. J., & Papachristou, G. I. (2019) · Nature Reviews Gastroenterology & Hepatology · doi:10.1038/s41575-019-0158-2 · Cited by 933 · see citing works
Acute Pancreatitis
Forsmark, C. E., Vege, S. S., & Wilcox, C. M. (2016) · New England Journal of Medicine · doi:10.1056/nejmra1505202 · Cited by 869 · see citing works
Global Incidence of Acute Pancreatitis Is Increasing Over Time: A Systematic Review and Meta-Analysis
Iannuzzi, J. P., King, J. A., Leong, J., Quan, J., Windsor, J. W., Tanyingoh, D., Coward, S. B., Forbes, N., Heitman, S. J., Shaheen, A. A., et al. (2021) · Gastroenterology · doi:10.1053/j.gastro.2021.09.043 · Cited by 839 · see citing works
Endoscopic management of acute necrotizing pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) evidence-based multidisciplinary guidelines
Arvanitakis, M., Dumonceau, J., Albert, J., Badaoui, A., Bali, M. A., Barthet, M. A., Besselink, M. G., Deviere, J. M. E., Ferreira, A. O., Gyokeres, T., et al. (2018) · Endoscopy · doi:10.1055/a-0588-5365 · Cited by 559 · see citing works
American College of Gastroenterology Guidelines: Management of Acute Pancreatitis
Tenner, S. M., Vege, S. S., Sheth, S. G., Sauer, B. G., Yang, A. L., Conwell, D. L., Yadlapati, R. H., & Gardner, T. B. (2023) · The American Journal of Gastroenterology · doi:10.14309/ajg.0000000000002645 · Cited by 535 · see citing works
Acute pancreatitis: recent advances through randomised trials
van Dijk, S. M., Hallensleben, N. D. L., van Santvoort, H. C., Fockens, P., van Goor, H., Bruno, M. J., & Besselink, M. G. (2017) · Gut · doi:10.1136/gutjnl-2016-313595 · Cited by 468 · see citing works
Japanese guidelines for the management of acute pancreatitis: Japanese Guidelines 2015
Yokoe, M., Takada, T., Mayumi, T., Yoshida, M., Isaji, S., Wada, K., Itoi, T., Sata, N., Gabata, T., Igarashi, H., et al. (2015) · Journal of Hepato-Biliary-Pancreatic Sciences · doi:10.1002/jhbp.259 · Cited by 416 · see citing works
Current Concepts in Severe Acute and Necrotizing Pancreatitis: An Evidence-Based Approach
Trikudanathan, G., Wolbrink, D. R. J., van Santvoort, H. C., Mallery, S., Freeman, M. L., & Besselink, M. G. (2019) · Gastroenterology · doi:10.1053/j.gastro.2019.01.269 · Cited by 416 · see citing works
Same-admission versus interval cholecystectomy for mild gallstone pancreatitis (PONCHO): a multicentre randomised controlled trial
da Costa, D. W., Bouwense, S. A. W., Schepers, N. J., Besselink, M. G., van Santvoort, H. C., van Brunschot, S., Bakker, O. J., Bollen, T. L., Dejong, C. H. C., van Goor, H., et al. (2015) · The Lancet · doi:10.1016/s0140-6736(15)00274-3 · Cited by 386 · see citing works
An Endoscopic Transluminal Approach, Compared With Minimally Invasive Surgery, Reduces Complications and Costs for Patients With Necrotizing Pancreatitis
Bang, J. Y., Arnoletti, J. P., Holt, B. A., Sutton, B. S., Hasan, M. K., Navaneethan, U., Feranec, N., Wilcox, C. M., Tharian, B., Hawes, R. H., et al. (2018) · Gastroenterology · doi:10.1053/j.gastro.2018.11.031 · Cited by 357 · see citing works
Pyroptosis in health and disease: mechanisms, regulation and clinical perspective
Liu, Y., Pan, R., Ouyang, Y., Gu, W., Xiao, T., Yang, H., Tang, L. Y., Wang, H., Xiang, B., & Chen, P. (2024) · Signal Transduction and Targeted Therapy · doi:10.1038/s41392-024-01958-2 · Cited by 364 · see citing works
Early versus On-Demand Nasoenteric Tube Feeding in Acute Pancreatitis
Bakker, O. J., van Brunschot, S., van Santvoort, H. C., Besselink, M. G., Bollen, T. L., Boermeester, M. A., Dejong, C. H., van Goor, H., Bosscha, K., Ali, U. A., et al. (2014) · New England Journal of Medicine · doi:10.1056/nejmoa1404393 · Cited by 339 · see citing works
Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis
de‐Madaria, E., Buxbaum, J. L., Maisonneuve, P., de Paredes, A. G. G., Zapater, P., Guilabert, L., Vaillo-Rocamora, A., Rodríguez-Gandía, M. Á., Donate, J., Hernández, E. E. L., et al. (2022) · New England Journal of Medicine · doi:10.1056/nejmoa2202884 · Cited by 343 · see citing works
Initial Medical Treatment of Acute Pancreatitis: American Gastroenterological Association Institute Technical Review
Vege, S. S., Dimagno, M. J., Forsmark, C. E., Martel, M., & Barkun, A. N. (2018) · Gastroenterology · doi:10.1053/j.gastro.2018.01.031 · Cited by 284 · see citing works
Management of Acute Pancreatitis in the Pediatric Population
Abu‐El‐Haija, M. A., Kumar, S., Quiros, J. A., Balakrishnan, K., Barth, B. A., Bitton, S., Eisses, J. F., Foglio, E. J., Fox, V. L., Francis, D., et al. (2017) · Journal of Pediatric Gastroenterology and Nutrition · doi:10.1097/mpg.0000000000001715 · Cited by 284 · see citing works
Immediate versus Postponed Intervention for Infected Necrotizing Pancreatitis
Boxhoorn, L., van Dijk, S. M., van Grinsven, J., Verdonk, R. C., Boermeester, M. A., Bollen, T. L., Bouwense, S. A. W., Bruno, M. J., Cappendijk, V. C., Dejong, C. H. C., et al. (2021) · New England Journal of Medicine · doi:10.1056/nejmoa2100826 · Cited by 286 · see citing works
Nonfasting mild-to-moderate hypertriglyceridemia and risk of acute pancreatitis
Pedersen, S. B., Langsted, A., & Nordestgaard, B. G. (2016) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2016.6875 · Cited by 270 · see citing works
ESPEN guideline on hospital nutrition
Thibault, R., Abbasoglu, O., Ioannou, E., Meija, L., Ottens-Oussoren, K., Pichard, C., Rothenberg, E., Rubin, D., Siljamäki-Ojansuu, U., Vaillant, M.-F., et al. (2021) · Clinical Nutrition · doi:10.1016/j.clnu.2021.09.039 · Cited by 259 · see citing works
“However solid food is not contraindicated but should be build up to a normal diet within days, judging by abdominal pain and postprandial pain [205].”
Background
Role of gut microbiota on intestinal barrier function in acute pancreatitis
Li, X.-Y., He, C., Zhu, Y., & Lü, N. (2020) · World Journal of Gastroenterology · doi:10.3748/wjg.v26.i18.2187 · Cited by 251 · see citing works
Infection increases mortality in necrotizing pancreatitis: A systematic review and meta-analysis
Werge, M. P., Novovic, S., Schmidt, P. N., & Gluud, L. L. (2016) · Pancreatology · doi:10.1016/j.pan.2016.07.004 · Cited by 242 · see citing works
“Current guidelines do not recommend the use of prophylactic antibiotics in necrotizing pancreatitis [82,83].”
Background
Laboratory markers predicting severity of acute pancreatitis
Staubli, S. M., Oertli, D., & Nebiker, C. A. (2015) · Critical Reviews in Clinical Laboratory Sciences · doi:10.3109/10408363.2015.1051659 · Cited by 229 · see citing works
Lipase or amylase for the diagnosis of acute pancreatitis?
Ismail, O. Z., & Bhayana, V. (2017) · Clinical Biochemistry · doi:10.1016/j.clinbiochem.2017.07.003 · Cited by 237 · see citing works
Superiority of Step-up Approach vs Open Necrosectomy in Long-term Follow-up of Patients With Necrotizing Pancreatitis
Hollemans, R. A., Bakker, O. J., Boermeester, M. A., Bollen, T. L., Bosscha, K. P., Bruno, M. J., Buskens, E., Dejong, C. H. C., van Duijvendijk, P., van Eijck, C. H. J., et al. (2018) · Gastroenterology · doi:10.1053/j.gastro.2018.10.045 · Cited by 228 · see citing works
Diagnosis and Management of Acute Pancreatitis
Trikudanathan, G., Yazıcı, C., Phillips, A. E., & Forsmark, C. E. (2024) · Gastroenterology · doi:10.1053/j.gastro.2024.02.052 · Cited by 242 · see citing works
Management of pancreatic fluid collections: A comprehensive review of the literature
Tyberg, A., Karia, K., Gabr, M. M., Desai, A. P., Doshi, R. H., Gaidhane, M. R., Sharaiha, R. Z., & Kahaleh, M. (2016) · World Journal of Gastroenterology · doi:10.3748/wjg.v22.i7.2256 · Cited by 200 · see citing works
Pharmacological interventions for acute pancreatitis
Moggia, E., Koti, R. S., Belgaumkar, A. P., Fazio, F., Pereira, S. P., Davidson, B. R., & Gurusamy, K. S. (2017) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd011384.pub2 · Cited by 193 · see citing works
Isoliquiritigenin Ameliorates Acute Pancreatitis in Mice via Inhibition of Oxidative Stress and Modulation of the Nrf2/HO‐1 Pathway
Liu, X., Zhu, Q., Zhang, M., Yin, T., Xu, R., Xiao, W., Wu, J., Deng, B., Gao, X., Gong, W., et al. (2018) · Oxidative Medicine and Cellular Longevity · doi:10.1155/2018/7161592 · Cited by 189 · see citing works
The Value of BISAP Score for Predicting Mortality and Severity in Acute Pancreatitis: A Systematic Review and Meta-Analysis
Gao, W., Yang, H., & Ma, C. (2015) · PLoS ONE · doi:10.1371/journal.pone.0130412 · Cited by 191 · see citing works
Nationwide Trends in Acute and Chronic Pancreatitis Among Privately Insured Children and Non-Elderly Adults in the United States, 2007–2014
Sellers, Z. M., MacIsaac, D., Yu, H., Dehghan, M. S., Zhang, K., Bensen, R., Wong, J. J., Kin, C., & Park, K. T. (2018) · Gastroenterology · doi:10.1053/j.gastro.2018.04.013 · Cited by 184 · see citing works
Minimally invasive and endoscopic versus open necrosectomy for necrotising pancreatitis: a pooled analysis of individual data for 1980 patients
van Brunschot, S., Hollemans, R. A., Bakker, O. J., Besselink, M. G., Baron, T. H., Beger, H. G., Boermeester, M. A., Bollen, T. L., Bruno, M. J., Carter, R., et al. (2017) · Gut · doi:10.1136/gutjnl-2016-313341 · Cited by 183 · see citing works
Review of Infectious Etiology of Acute Pancreatitis
Rawla, P., Bandaru, S. S., & Vellipuram, A. (2017) · Gastroenterology Research · doi:10.14740/gr858w · Cited by 182 · see citing works
“Benign or malignant strictures of the pancreatic duct are associated with AP in about 5-14% patients [5].”
Fluid resuscitation with lactated Ringer’s solution vs normal saline in acute pancreatitis: A triple-blind, randomized, controlled trial
de‐Madaria, E., Herrera-Marante, I., González-Camacho, V., Bonjoch, L., Quesada‐Vázquez, N., Almenta-Saavedra, I., Miralles, C., Acevedo–Piedra, N. G., Roger-Ibáñez, M., Sánchez‐Marin, C., et al. (2017) · United European Gastroenterology Journal · doi:10.1177/2050640617707864 · Cited by 173 · see citing works
“Our primary aim was to compare the effect of LR vs NS on the systemic inflammatory response of patients with AP.”
Influential
AKI Associated with Acute Pancreatitis
Nassar, T. I., & Qunibi, W. Y. (2019) · Clinical Journal of the American Society of Nephrology · doi:10.2215/cjn.13191118 · Cited by 174 · see citing works
“Although some clinical trials have shown a clear benefit of aggressive hydration, others reported that aggressive hydration might be associated with increased morbidity and mortality (2).”
BackgroundInfluential
Admission Hematocrit and Rise in Blood Urea Nitrogen at 24 h Outperform other Laboratory Markers in Predicting Persistent Organ Failure and Pancreatic Necrosis in Acute Pancreatitis: A Post Hoc Analysis of Three Large Prospective Databases
Koutroumpakis, E., Wu, B. U., Bakker, O. J., Dudekula, A. B., Singh, V. K., Besselink, M. G., Yadav, D. K., van Santvoort, H. C., Whitcomb, D. C., Gooszen, H. G., et al. (2015) · The American Journal of Gastroenterology · doi:10.1038/ajg.2015.370 · Cited by 171 · see citing works
Consensus guidelines on severe acute pancreatitis
Pezzilli, R., Zerbi, A., Campra, D., Capurso, G., Golfieri, R., Arcidiacono, P. G., Billi, P., Butturini, G., Calculli, L., Cannizzaro, R., et al. (2015) · Digestive and Liver Disease · doi:10.1016/j.dld.2015.03.022 · Cited by 171 · see citing works
Staged multidisciplinary step-up management for necrotizing pancreatitis
da Costa, D. W., Boerma, D., van Santvoort, H. C., Horvath, K. D., Werner, J., Carter, C. R., Bollen, T. L., Gooszen, H. G., Besselink, M. G., & Bakker, O. J. (2013) · British journal of surgery · doi:10.1002/bjs.9346 · Cited by 168 · see citing works
Hypertriglyceridemia-induced pancreatitis: updated review of current treatment and preventive strategies
Rawla, P., Sunkara, T., Thandra, K. C., & Gaduputi, V. V. (2018) · Clinical Journal of Gastroenterology · doi:10.1007/s12328-018-0881-1 · Cited by 169 · see citing works
Peripancreatic fat necrosis worsens acute pancreatitis independent of pancreatic necrosis via unsaturated fatty acids increased in human pancreatic necrosis collections
Noel, P., Patel, K. S., Durgampudi, C., Trivedi, R. N., de Oliveira, C., Crowell, M. D., Pannala, R., Lee, K., Brand, R. E., Chennat, J. S., et al. (2014) · Gut · doi:10.1136/gutjnl-2014-308043 · Cited by 163 · see citing works
Urgent endoscopic retrograde cholangiopancreatography with sphincterotomy versus conservative treatment in predicted severe acute gallstone pancreatitis (APEC): a multicentre randomised controlled trial
Schepers, N. J., Hallensleben, N. D. L., Besselink, M. G., Anten, M.-P., Bollen, T. L., da Costa, D. W., van Delft, F., van Dijk, S. M., van Dullemen, H. M., Dijkgraaf, M. G. W., et al. (2020) · The Lancet · doi:10.1016/s0140-6736(20)30539-0 · Cited by 173 · see citing works
Multifactorial Scores and Biomarkers of Prognosis of Acute Pancreatitis: Applications to Research and Practice
Silva-Vaz, P., Abrantes, A. M., Castelo-Branco, M., Gouveia, A., Botelho, M. F., & Tralhão, J. G. (2020) · International Journal of Molecular Sciences · doi:10.3390/ijms21010338 · Cited by 164 · see citing works
Worldwide Variations in Demographics, Management, and Outcomes of Acute Pancreatitis
Matta, B. N., Gougol, A., Gao, X., Reddy, D. N., Talukdar, R., Kochhar, R. K., Goenka, M. K., Gulla, A., González, J. A., Singh, V. K., et al. (2019) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2019.11.017 · Cited by 159 · see citing works
“001* -Severe, median (IQR) 28 (25- 41) 19 (13-25) 19 (13 -25) 20 (13.”
The emerging concept of fluid tolerance: A position paper
Kattan, E., Castro, R., Miralles-Aguiar, F., Glenn Hernández, P., & Rola, P. (2022) · Journal of Critical Care · doi:10.1016/j.jcrc.2022.154070 · Cited by 160 · see citing works
Pancreatic exocrine insufficiency following acute pancreatitis: Systematic review and study level meta-analysis
Hollemans, R. A., Hallensleben, N. D. L., Mager, D. J., Kelder, J. C., Besselink, M. G., Bruno, M. J., Verdonk, R. C., & van Santvoort, H. C. (2018) · Pancreatology · doi:10.1016/j.pan.2018.02.009 · Cited by 155 · see citing works
Management of acute pancreatitis in the first 72 hours
James, T., & Crockett, S. D. (2018) · Current Opinion in Gastroenterology · doi:10.1097/mog.0000000000000456 · Cited by 158 · see citing works
“It should be noted that aggressive fluid resuscitation is most useful in the first 12–24 h of admission, and should generally be curtailed after this point to ovoid fluid overload [5,38,39].”
Influential
Early (<4 Weeks) Versus Standard (≥ 4 Weeks) Endoscopically Centered Step-Up Interventions for Necrotizing Pancreatitis
Trikudanathan, G., Tawfik, P. N., Amateau, S. K., Satish Munigala, M. B. B. S., Arain, M. A., Attam, R., Beilman, G. J., Flanagan, S. M., Freeman, M. L., & Mallery, S. (2018) · The American Journal of Gastroenterology · doi:10.1038/s41395-018-0232-3 · Cited by 152 · see citing works
Severity stratification and prognostic prediction of patients with acute pancreatitis at early phase
Zhou, H., Mei, X., He, X., Lan, T., & Guo, S. (2019) · Medicine · doi:10.1097/md.0000000000015275 · Cited by 153 · see citing works
“4 cases per 100,000 individuals worldwide.([1]) Although in the majority of patients the disease is mild and associated with good prognosis, 15% to 20%of patients with AP develop into severe clinical course with higher morbidity and mortality rates.”
BackgroundMethodResult
Evaluation and management of acute pancreatitis
Chatila, A. T., Bilal, M., & Guturu, P. (2019) · World Journal of Clinical Cases · doi:10.12998/wjcc.v7.i9.1006 · Cited by 154 · see citing works
Epidemiology, aetiology and outcomes of acute pancreatitis: A retrospective cohort study
Nesvaderani, M., Eslick, G. D., Vagg, D., Faraj, S., & Cox, M. R. (2015) · International Journal of Surgery · doi:10.1016/j.ijsu.2015.07.701 · Cited by 149 · see citing works
Early Aggressive Hydration Hastens Clinical Improvement in Mild Acute Pancreatitis
Buxbaum, J. L., Quezada, M., Da, B. L., Jani, N. D., Lane, C. J., Mwengela, D., Kelly, T., Jhun, P., Dhanireddy, K. K., & Laine, L. (2017) · The American Journal of Gastroenterology · doi:10.1038/ajg.2017.40 · Cited by 146 · see citing works
“(0–10 scale) (median (IQR)) 8 (2) 8 (3) 0.”
Prevalence, Risk Factors, and Outcomes of Hospitalized Patients With Coronavirus Disease 2019 Presenting as Acute Pancreatitis
Inamdar, S., Benias, P. C., Liu, Y., Sejpal, D. V., Satapathy, S. K., & Trindade, A. J. (2020) · Gastroenterology · doi:10.1053/j.gastro.2020.08.044 · Cited by 139 · see citing works
International Association of Pancreatology Revised Guidelines on Acute Pancreatitis 2025: Supported and Endorsed by the American Pancreatic Association, European Pancreatic Club, Indian Pancreas Club, and Japan Pancreas Society
Párniczky, A., Mikó, A., Uç, A., Singh, A. N., Elhence, A., Saluja, A., Masamune, A., Dayyeh, B. K. A., Davidson, B. R., Wilcox, C. M., et al. (2025) · Pancreatology · doi:10.1016/j.pan.2025.04.020 · Cited by 159 · see citing works
National lipid association annual summary of clinical lipidology 2016
Bays, H. E., Jones, P. H., Orringer, C. E., Brown, W. V., & Jacobson, T. A. (2016) · Journal of Clinical Lipidology · doi:10.1016/j.jacl.2015.08.002 · Cited by 128 · see citing works
Serum amylase and lipase and urinary trypsinogen and amylase for diagnosis of acute pancreatitis
Rompianesi, G., Hann, A., Komolafe, O., Pereira, S. P., Davidson, B. R., & Gurusamy, K. S. (2017) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd012010.pub2 · Cited by 132 · see citing works
Extra-hepatic manifestations associated with hepatitis E virus infection: a comprehensive review of the literature
Bazerbachi, F., Haffar, S., Garg, S. K., & Lake, J. R. (2015) · Gastroenterology report · doi:10.1093/gastro/gov042 · Cited by 129 · see citing works
“All cases fulfilled the criteria of the American College of Gastroenterology for the diagnosis of AP [37].”
Method
Aktualisierte S3-Leitlinie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) und der Deutschen Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV) zur Prävention, Diagnostik und Behandlung von Gallensteinen
Gutt, C. N., Jenssen, C., Barreiros, A. P., Götze, T. O., Stokes, C. S., Jansen, P. L., Neubrand, M., Lammert, F., der Konsensuskonferenz, F. D. T., (DGIM), D. G. F. I. M. E. V., et al. (2018) · Zeitschrift für Gastroenterologie · doi:10.1055/a-0644-2972 · Cited by 129 · see citing works
“[735] Tenner S, Baillie J, DeWitt J et al.”
Background
Clinical and Genetic Risk Factors for Acute Pancreatitis in Patients With Acute Lymphoblastic Leukemia
Liu, C., Yang, W., Devidas, M., Cheng, C., Pei, D., Smith, C. J., Carroll, W. L., Raetz, E. A., Bowman, W. P., Larsen, E. C., et al. (2016) · Journal of Clinical Oncology · doi:10.1200/jco.2015.64.5812 · Cited by 126 · see citing works
“There is no specific treatment of acute pancreatitis; only supportive care is given.(36) Thus, the genetic and nongenetic risk factors we discovered in this largest study to date may have importance for understanding the mechanisms and developing targeted interventions for patients with predisposition to pancreatitis.”
Background
The Anti-Inflammatory and Curative Exponent of Probiotics: A Comprehensive and Authentic Ingredient for the Sustained Functioning of Major Human Organs
Virk, M. S., Virk, M. A., He, Y., Tufail, T., Gul, M., Qayum, A., Rehman, A., Rashid, A., Ekumah, J., Han, X., et al. (2024) · Nutrients · doi:10.3390/nu16040546 · Cited by 137 · see citing works
Familial chylomicronemia syndrome: Bringing to life dietary recommendations throughout the life span
Williams, L., Rhodes, K. S., Karmally, W., Welstead, L. A., Alexander, L., & Sutton, L. (2018) · Journal of Clinical Lipidology · doi:10.1016/j.jacl.2018.04.010 · Cited by 125 · see citing works
“During attacks of acute pancreatitis, early aggressive IV hydration with 250 to 500 mL/h may prevent intravascular volume depletion and pancreatic necrosis.(50,51) Ideally, initiating IV hydration within the first 12 hours of acute pancreatitis onset may prevent further complications.”
Background
EPC/HPSG evidence-based guidelines for the management of pediatric pancreatitis
Párniczky, A., Abu‐El‐Haija, M. A., Husain, S. Z., Lowe, M. E., Oracz, G., Sahin‐Tóth, M., Szabó, F., Uç, A., Wilschanski, M. A., Witt, H., et al. (2018) · Pancreatology · doi:10.1016/j.pan.2018.01.001 · Cited by 126 · see citing works
“A small percentage of the cases with confirmed infected necrosis, whose clinical status is stable, can be treatedwith only antibiotics, without the need for drainage or necrosectomy [112,113].”
BackgroundInfluential
Pancreatic Cancer Following Acute Pancreatitis: A Population-based Matched Cohort Study
Sadr‐Azodi, O., Oskarsson, V., Discacciati, A., Videhult, P., Askling, J., & Ekbom, A. (2018) · The American Journal of Gastroenterology · doi:10.1038/s41395-018-0255-9 · Cited by 125 · see citing works
Acute Pancreatitis
Gardner, T. B. (2021) · Annals of Internal Medicine · doi:10.7326/aitc202102160 · Cited by 122 · see citing works
Low-grade inflammation in the association between mild-to-moderate hypertriglyceridemia and risk of acute pancreatitis: a study of more than 115000 individuals from the general population
Hansen, S. E. J., Madsen, C. M., Varbo, A., & Nordestgaard, B. G. (2019) · Clinical Chemistry · doi:10.1373/clinchem.2018.294926 · Cited by 121 · see citing works
Interventions for necrotising pancreatitis
Gurusamy, K. S., Belgaumkar, A. P., Haswell, A., Pereira, S. P., & Davidson, B. R. (2016) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd011383.pub2 · Cited by 118 · see citing works
Acute Pancreatitis: Revised Atlanta Classification and the Role of Cross-Sectional Imaging
Zhao, K., Adam, S. Z., Keswani, R. N., Horowitz, J. M., & Miller, F. H. (2015) · American Journal of Roentgenology · doi:10.2214/ajr.14.14056 · Cited by 120 · see citing works
“Despite this, imaging for the detection of necrosis within the early phase is generally only indicated in deteriorating or critically ill patients and must be interpreted cautiously [7].”
BackgroundMethodInfluential
Clinical Profile and Natural Course in a Large Cohort of Patients With Hypertriglyceridemia and Pancreatitis
Vipperla, K., Somerville, C., Furlan, A., Koutroumpakis, E., Saul, M. I., Chennat, J. S., Rabinovitz, M., Whitcomb, D. C., Slivka, A., Papachristou, G. I., et al. (2016) · Journal of Clinical Gastroenterology · doi:10.1097/mcg.0000000000000579 · Cited by 121 · see citing works
Acute Pancreatitis: Updates for Emergency Clinicians
Waller, A., Long, B., Koyfman, A., & Gottlieb, M. A. (2018) · Journal of Emergency Medicine · doi:10.1016/j.jemermed.2018.08.009 · Cited by 128 · see citing works
Azathioprine-induced Acute Pancreatitis in Patients with Inflammatory Bowel Diseases—A Prospective Study on Incidence and Severity
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Abdominal Compartment Syndrome and Intra‐abdominal Ischemia in Patients with Severe Acute Pancreatitis
Smit, M., Buddingh, K. T., Bosma, B., Nieuwenhuijs, V. B., Hofker, H. S., & Zijlstra, J. G. (2016) · World Journal of Surgery · doi:10.1007/s00268-015-3388-7 · Cited by 110 · see citing works
“Three commonly used guidelines by the British Society of Gastroenterology [20], the American College of Gastroenterology [21], and the American Gastroenterological Association [22] do not yet mention the need for routine IAP measurements.”
Method
Caffeine protects against experimental acute pancreatitis by inhibition of inositol 1,4,5-trisphosphate receptor-mediated Ca 2+ release
Huang, W., Cane, M. C., Mukherjee, R., Szatmary, P., Zhang, X., Elliott, V., Ouyang, Y., Chvanov, M., Latawiec, D., Wen, L., et al. (2015) · Gut · doi:10.1136/gutjnl-2015-309363 · Cited by 108 · see citing works
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“Further randomized trials utilizing prophylactic antibiotics have failed to show benefit [8].”
BackgroundInfluential
Systemic immune-inflammation index (SII) can be an early indicator for predicting the severity of acute pancreatitis: a retrospective study.
Liu, X., Guan, G., Cui, X., Liu, Y., Liu, Y., & Luo, F. (2021) · International Journal of General Medicine · doi:10.2147/ijgm.s343110 · Cited by 105 · see citing works
“29,33 In recent years, studies have explored the use of new types of severity and predictive scores such as NLR and PLR for predicting the severity of pancreatitis.”
Lumen apposing metal stents are superior to plastic stents in pancreatic walled-off necrosis: a large international multicenter study
Chen, Y., Yang, J. F., Friedland, S., Holmes, I., Law, R. J., Hosmer, A. E., Stevens, T., Franco, M. C., Jang, S. N., Pawa, R., et al. (2019) · Endoscopy International Open · doi:10.1055/a-0828-7630 · Cited by 105 · see citing works
Enteral nutrition in acute pancreatitis: A review of the current evidence
Oláh, A., & Romics, L. (2014) · World Journal of Gastroenterology · doi:10.3748/wjg.v20.i43.16123 · Cited by 107 · see citing works
Contemporary review of drug-induced pancreatitis: A different perspective
Hung, W. Y. (2014) · World Journal of Gastrointestinal Pathophysiology · doi:10.4291/wjgp.v5.i4.405 · Cited by 104 · see citing works
Timing of catheter drainage in infected necrotizing pancreatitis
for the Dutch Pancreatitis Study Group, van Grinsven, J., van Santvoort, H. C., Boermeester, M. A., Dejong, C. H. C., van Eijck, C. H. J., Fockens, P., & Besselink, M. G. (2016) · Nature Reviews Gastroenterology & Hepatology · doi:10.1038/nrgastro.2016.23 · Cited by 104 · see citing works
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Valverde‐López, F., Matas-Cobos, A. M., Alegría-Motte, C., Jiménez‐Rosales, R., Úbeda‐Muñoz, M., & Redondo‐Cerezo, E. (2017) · Journal of Gastroenterology and Hepatology · doi:10.1111/jgh.13763 · Cited by 104 · see citing works
Enhanced Neutrophil Extracellular Trap Formation in Acute Pancreatitis Contributes to Disease Severity and Is Reduced by Chloroquine
Murthy, P., Singhi, A. D., Ross, M. A., Loughran, P., Paragomi, P., Papachristou, G. I., Whitcomb, D. C., Zureikat, A. H., Lotze, M. T., Zeh, H. J., et al. (2019) · Frontiers in Immunology · doi:10.3389/fimmu.2019.00028 · Cited by 105 · see citing works
“care, highlighting the critical need for novel therapies that target the underlying pathophysiology of the disease (1).”
Background
S3-Leitlinie Pankreatitis – Leitlinie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) – September 2021 – AWMF Registernummer 021-003
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Diabetes following acute pancreatitis
Hart, P. A., Bradley, D. P., Conwell, D. L., Dungan, K. M., Krishna, S. G., Wyne, K. L., Bellin, M. D., Yadav, D. K., Andersen, D. K., Serrano, J., et al. (2021) · The Lancet. Gastroenterology & hepatology · doi:10.1016/s2468-1253(21)00019-4 · Cited by 106 · see citing works
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Lactated Ringer's solution in combination with rectal indomethacin for prevention of post-ERCP pancreatitis and readmission: a prospective randomized, double-blinded, placebo-controlled trial
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The role of endoscopy in benign pancreatic disease
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Diagnostic strategy and timing of intervention in infected necrotizing pancreatitis: an international expert survey and case vignette study
van Grinsven, J., van Brunschot, S., Bakker, O. J., Bollen, T. L., Boermeester, M. A., Bruno, M. J., Dejong, C. H. C., Dijkgraaf, M. G. W., van Eijck, C. H. J., Fockens, P., et al. (2015) · HPB · doi:10.1016/j.hpb.2015.07.003 · Cited by 100 · see citing works
Acute Pancreatitis—Progress and Challenges
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“The diagnosis of AP was defined as the presence of at least two of the three following criteria: 1) Epigastric abdominal pain that is typical of AP, 2) Serum amylase or lipase elevated to greater than three times the upper limit of normal, and/or 3) CT scan (or less commonly magnetic resonance imaging [MRI]) findings…”
Background
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“, within 24 hours) for SAP associated with acute cholangitis, as a delay is associated with an increased risk of mortality (16,17,147-149).”
Background
Nutritional Support in Patients with Severe Acute Pancreatitis-Current Standards
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“EEN is also associated with a shorter duration of hospitalization and lower hospital costs [46,47].”
Background
Imaging in pancreatic disease
Dimastromatteo, J., Brentnall, T. A., & Kelly, K. A. (2016) · Nature Reviews Gastroenterology & Hepatology · doi:10.1038/nrgastro.2016.144 · Cited by 90 · see citing works

Authors: Tenner, S., Baillie, J., DeWitt, J., & Vege, S. S.
Affiliations: SUNY Downstate Health Sciences University (US)
Carteret General Hospital (US)
Mayo Clinic (US)
Corresponding author: Vege, Santhi Swaroop
ORCID: Baillie, John
DeWitt, John
Vege, Santhi Swaroop
Venue: American Journal of Gastroenterology
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2013-09
Volume: 108
Issue: 9
Pages: 1400-1415
ISSN: 0002-9270 (ISSN-L)
DOI: 10.1038/ajg.2013.218
OpenAlex: W1972516036
Semantic Scholar: 47448440997e168032405b8c54dc2587912c980b
Cited by: 2,327
References: 164
Citations by year: 2026: 110 · 2025: 117 · 2024: 179 · 2023: 256 · 2022: 250 · 2021: 244 · 2020: 220 · 2019: 191 · 2018: 192 · 2017: 175 · 2016: 144 · 2015: 159 · 2014: 82 · 2013: 3 · 2012: 2
FWCI: 125.98
Type: journal article
Language: en
Update notices: erratum (2014-02-05)
Open access: closed
Licence: www.springer.com/tdm (unspecified)
Locations: The American Journal of Gastroenterology (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Surgery › Pancreatitis Pathology and Treatment
Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Gallbladder and Bile Duct Disorders
Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
Keywords: acute pancreatitis, contrast-enhanced CT, hemodynamic resuscitation, systemic inflammatory response syndrome, intensive care unit admission, intravenous hydration, acute cholangitis, endoscopic retrograde cholangiopancreatography, post-ERCP pancreatitis, pancreatic stent, antibiotic prophylaxis, infected pancreatic necrosis, sterile pancreatic necrosis, enteral nutrition, parenteral nutrition, pancreatic pseudocyst
MeSH terms: Acute Disease, Cholangiopancreatography, Endoscopic Retrograde, Drainage, Gastroenterology, Humans, Pancreas, Pancreatic Ducts, Pancreatitis, Prognosis

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