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

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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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Method
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Dachs, R. J., Sullivan, L., & Shanmugathasan, P. (2014) · Emergency Radiology · doi:10.1007/s10140-014-1266-5 · Cited by 23
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BackgroundInfluential
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MethodInfluential
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Background
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Background
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Influential
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BackgroundMethodInfluential
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Background
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Background
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“Urinmenge Klinische Auswertungen zu Patienten auf Überwachungsstationen belegen, dass Informationen über Oligurie, Anurie bzw. eingeschränkte Diuresemengen als unabhängige, hochsensitive und frühzeitige Marker für die Diagnose eines AKI verwendet werden können [88–90].”
BackgroundInfluential
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A critical evaluation of serum lipase and amylase as diagnostic tests for acute pancreatitis
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“The current ACG practice guidelines for the diagnosis and management of AP recommend that in patient presenting with abdominal pain consistent with AP, a serum lipase and/or amylase level greater than 3 times ULN is diagnostic of AP [4].”
BackgroundMethodInfluential
Use of Celecoxib Correlates With Increased Relative Risk of Acute Pancreatitis: A Case–Control Study in Taiwan
Hung, S., Hung, S.-R., Lin, C., Lai, S., & Hung, H. (2015) · The American Journal of Gastroenterology · doi:10.1038/ajg.2015.259 · Cited by 20
Fluid Collections and Pseudocysts as a Complication of Acute Pancreatitis
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Clinical outcomes of acute pancreatitis in elderly patients: An experience of single tertiary center
Kayar, Y., Dertli, R., & Konür, Ş. (2020) · Pancreatology · doi:10.1016/j.pan.2020.06.006 · Cited by 20
Early endoscopic treatment of symptomatic pancreatic necrotic collections
Jagielski, M., Piątkowski, J., & Jackowski, M. (2022) · Scientific Reports · doi:10.1038/s41598-021-03924-2 · Cited by 20
Hypertriglyceridemia-Induced Acute Pancreatitis – Course, Outcome, and Comparison with Non-Hypertriglyceridemia Associated Pancreatitis
Shafiq, S., Patil, M. N., Gowda, V., & Devarbhavi, H. C. (2022) · Indian Journal of Endocrinology and Metabolism · doi:10.4103/ijem.ijem_206_22 · Cited by 20
Update on the strategy for intravenous fluid treatment in acute pancreatitis
Yaowmaneerat, T., & Sirinawasatien, A. (2023) · World Journal of Gastrointestinal Pharmacology and Therapeutics · doi:10.4292/wjgpt.v14.i3.22 · Cited by 23
Antibiotic Utilization in Acute Pancreatitis: A Narrative Review
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“In the case of extrapancreatic infection, antibiotic therapy is always recommended [25,26]”
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Effectiveness and safety of low molecular weight heparin in the management of acute pancreatitis: a systematic review and meta-analysis
Podda, M., Murzi, V., Marongiu, P., Martino, M. D., de Simone, B. D., Jayant, K., Ortenzi, M., Coccolini, F., Sartelli, M., Catena, F., et al. (2024) · World Journal of Emergency Surgery · doi:10.1186/s13017-024-00558-3 · Cited by 20
Biliary Pancreatitis : Deadly Threat to the Elderly : Is It a Real Threat ?
Malik, A. M. (2015) · International Journal of Health Sciences · doi:10.12816/0024681 · Cited by 20
“(11) Many such elderly patients with pain in abdomen are treated as acute MI or duodenal ulcers and eventually this misdiagnosis loses the initial period where patients could be effectively treated and saved.”
Background
Pancreatitis after human papillomavirus vaccination: a matter of molecular mimicry
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“computed tomography, magnetic resonance imaging, ultrasound) [2].”
Abdominal paracentesis drainage improves tolerance of enteral nutrition in acute pancreatitis: a randomized controlled trial
Hongyin, L., Huang, Z., Wang, T., Ning, L., Weihui, L., Jianfeng, C., Hongtao, Y., & Lijun, T. (2017) · Scandinavian Journal of Gastroenterology · doi:10.1080/00365521.2016.1276617 · Cited by 20
“Additionally, EN is recommended as the preferable nutritional approach for acute pancreatitis according to several recently published guidelines, although the timing and route of EN remain controversial [3,4].”
BackgroundMethod
N,N-Dimethyl Tertiary Amino Group Mediated Dual Pancreas- and Lung-Targeting Therapy against Acute Pancreatitis
Luo, S., Li, P., Li, S., Du, Z., Hu, X., Fu, Y. S., & Zhang, Z. (2017) · Molecular Pharmaceutics · doi:10.1021/acs.molpharmaceut.7b00028 · Cited by 20
Changing the electronic request form proves to be an effective tool for optimizing laboratory test utilization in the emergency department
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Effects of HV-CRRT on PCT, TNF-α, IL-4, IL-6, IL-8 and IL-10 in patients with pancreatitis complicated by acute renal failure
Liu, C., Li, M., Cao, S., Wang, J., Huang, X., & Weizhen, Z. (2017) · Experimental and Therapeutic Medicine · doi:10.3892/etm.2017.4843 · Cited by 20
Initial Pain Management in Pediatric Acute Pancreatitis
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Minimally invasive surgery in the era of step-up approach for treatment of severe acute pancreatitis
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Managing Infected Pancreatic Necrosis
Thomson, J., van Dijk, S. M., Brand, M., van Santvoort, H. C., & Besselink, M. G. (2018) · Chirurgia · doi:10.21614/chirurgia.113.3.291 · Cited by 20
“Some authors have advocated early ERCP intervention in all patients with (predicted) severe biliary pancreatitis (61,62), however this has not become standard of care (10,47).”
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The utility of early cross-sectional imaging to evaluate suspected acute mild pancreatitis
Reynolds, P. T. (2018) · Annals of Gastroenterology · doi:10.20524/aog.2018.0291 · Cited by 20
Proteomic Identification of Novel Plasma Biomarkers and Pathobiologic Pathways in Alcoholic Acute Pancreatitis
Waldron, R. T., Lugea, A., Gulla, A., & Pandol, S. J. (2018) · Frontiers in Physiology · doi:10.3389/fphys.2018.01215 · Cited by 20
Endoscopic Ultrasound for Routine Assessment in Idiopathic Acute Pancreatitis
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Role of extrapancreatic necrosis volume in determining early prognosis in patients with acute pancreatitis
Çakar, İ., Keven, A., Eseroğlu, E., & Çubuk, M. (2019) · Abdominal Radiology · doi:10.1007/s00261-019-02188-9 · Cited by 20
“The CRP is the most useful biochemical marker used to determine the severity and complications of AP [4, 7].”
BackgroundMethodInfluential
Gene–environment interaction between APOA5 c.553G>T and pregnancy in hypertriglyceridemia-induced acute pancreatitis
Pu, N., Yang, Q., Shi, X., Chen, W., Li, X., Zhang, G., Li, G., Li, B., Ke, L., Tong, Z., et al. (2020) · Journal of clinical lipidology · doi:10.1016/j.jacl.2020.05.003 · Cited by 21
“4 per 100,000 individuals 74 worldwide.(1) Its incidence is increasing in recent years and its mean mortality rate has reached 2%.”
Background
Multiorgan Failure Predicts Mortality in Emphysematous Pancreatitis
Bul, V., Yazıcı, C., Staudacher, J. J., Jung, B. H., & Boulay, B. R. (2017) · Pancreas · doi:10.1097/mpa.0000000000000834 · Cited by 20
Assessment of acute pancreatitis severity via determination of serum levels of hsa‑miR‑126‑5p and IL‑6
Chen, Y., Lin, T., Cai, Z., Yan, C.-H., Gou, S.-R., & Zhuang, Y.-D. (2020) · Experimental and Therapeutic Medicine · doi:10.3892/etm.2020.9458 · Cited by 20
Serum triglyceride levels are associated with recurrence in patients with acute hypertriglyceridemic pancreatitis
Guan, L., Ding, L., Wan, J., Xia, L., He, W., Xiong, H., Luo, L.-Y., Lü, N., & Zhu, Y. (2023) · Frontiers in Medicine · doi:10.3389/fmed.2023.1079637 · Cited by 19
Adverse Effects Associated With Newer Diabetes Therapies
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Approach to Patients with Epigastric Pain
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The safety, feasibility, and cost-effectiveness of early laparoscopic cholecystectomy for patients with mild acute biliary pancreatitis: A meta-analysis
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Comparison of early and delayed cholecystectomy for biliary pancreatitis: A meta-analysis
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Early Weight-Based Aggressive vs. Non-Aggressive Goal-Directed Fluid Resuscitation in the Early Phase of Acute Pancreatitis: An Open-Label Multicenter Randomized Controlled Trial (The WATERFALL Trial), Design, and Rationale
Bolado, F., Buxbaum, J. L., Vaillo-Rocamora, A., Cárdenas‐Jaén, K., Maisonneuve, P., & de‐Madaria, E. (2020) · Frontiers in Medicine · doi:10.3389/fmed.2020.00440 · Cited by 19
An Updated Systematic Review With Meta-analysis
Chen, Y., Zhang, Y., Yang, Q., Lee, P., Windsor, J. A., & Wu, D. (2021) · Pancreas · doi:10.1097/mpa.0000000000001734 · Cited by 19
Association between high-density lipoprotein cholesterol and apolipoprotein A-I and severe acute pancreatitis: a case-control study
Li, Y., Zheng, R., Gao, F., Wang, L., Feng, S., Li, J., & Huang, Z. (2021) · European Journal of Gastroenterology & Hepatology · doi:10.1097/meg.0000000000002095 · Cited by 19
Acute necrotising pancreatitis: measurements of necrosis volume and mean CT attenuation help early prediction of organ failure and need for intervention
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Decreased skeletal muscle density is an independent predictor of mortality in necrotizing pancreatitis- A single tertiary center experience in 507 patients
Trikudanathan, G., Vantanasiri, K., Faizi, N. A., Munigala, S., Vaněk, P., Schat, R., Freeman, M. L., & Chauhan, A. (2021) · Pancreatology · doi:10.1016/j.pan.2021.05.010 · Cited by 19
Safety and clinical outcomes of early dual modality drainage (< 28 days) compared to later drainage of pancreatic necrotic fluid collections: a propensity score-matched study
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Role of serum C-reactive protein (CRP)/Albumin ratio in predicting the severity of acute pancreatitis: A retrospective cohort
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“With this limitation, most clinical management guidelines [5,6], emphasize an approach that includes predicting and establishing”
Background
Proanthocyanidins suppress NLRP3 inflammasome and M1 macrophage polarization to alleviate severe acute pancreatitis in mice
Sheng, L., Han, C., Ling, X., Guo, X., Lin, R., & Ding, Z. (2022) · Journal of Biochemical and Molecular Toxicology · doi:10.1002/jbt.23242 · Cited by 19
Time to think prime times for treatment of necrotizing pancreatitis: Pendulum conundrum
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Medical management of hypertriglyceridemia in pancreatitis
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BackgroundInfluential
Enteral nutrition tube placement assisted by ultrasonography in patients with severe acute pancreatitis
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“Normally, the diagnosis of AP is apparent in many patients, and most patients with AP have a mild, uncomplicated course.(1) However, imaging could be handy in the timely diagnosis and management of AP with atypical presentation, such as with normal or small elevated levels of pancreatic enzymes, as abdominal imaging i…”
Influential
Outcome of patients with acute pancreatitis requiring intensive care admission: A retrospective study from a tertiary care center of Pakistan
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The impact of empiric endoscopic biliary sphincterotomy on future gallstone-related complications in patients with non-severe acute biliary pancreatitis whose cholecystectomy was deferred or not performed
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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
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 › Gastroenterology › Gallbladder and Bile Duct Disorders
Health Sciences › Medicine › Critical Care and Intensive Care Medicine › 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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American College of Gastroenterology Guideline: Management of Acute Pancreatitis

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