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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Lactated Ringer Solution Is Superior to Normal Saline Solution in Managing Acute Pancreatitis
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BackgroundResult
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Result
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BackgroundResult
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Zhang, P., Yu, B., Men, W., Bai, R.-Y., Chen, M., Wang, Z., Zeng, T., & Zhou, K. (2020) · International Immunopharmacology · doi:10.1016/j.intimp.2020.106682 · Cited by 14
Early on-demand drainage versus standard management among acute necrotizing pancreatitis patients complicated by persistent organ failure: The protocol for an open-label multi-center randomized controlled trial
Qu, C., Zhang, H., Chen, T., Zhu, Y., Feng, Q., Guo, F., Liu, Z., Cao, L., Yang, J., Li, G., et al. (2020) · Pancreatology · doi:10.1016/j.pan.2020.08.012 · Cited by 14
Development and validation of a computed tomography index for assessing outcomes in patients with acute pancreatitis: “SMART-CT” index
Gupta, P. C., Kumar, P. M., Verma, M., Sharma, V., Samanta, J., Mandavdhare, H. S., Sinha, S. K., Dutta, U., & Kochhar, R. K. (2020) · Abdominal Radiology · doi:10.1007/s00261-020-02740-y · Cited by 14
“Hence, we employed SMOTE in which there is both oversampling of minority class and under-sampling of the majority class as a pre-processing step before fitting the data to the model to increase the inclination of the algorithm to detect the minority class [14, 15].”
MethodResultInfluential
Development and Validation of a Novel Prognostic Score Based on Thrombotic and Inflammatory Biomarkers for Predicting 28-Day Adverse Outcomes in Patients with Acute Pancreatitis
Han, T., Cheng, T., Liao, Y., He, Y., Liu, B., Lai, Q., Pan, P., Liu, J., Lei, C., & Cao, Y. (2022) · Journal of Inflammation Research · doi:10.2147/jir.s344446 · Cited by 14
“An increase in the annual incidence of AP has been observed in most recent studies.(21) Early severity-based stratification and prognostic prediction are crucial for reducing the rates of mortality among patients with AP.”
Result
Acute pancreatitis with normal amylase and lipase—an ED dilemma
Singh, A., Shrestha, M., & Anand, C. P. (2015) · The American Journal of Emergency Medicine · doi:10.1016/j.ajem.2015.10.026 · Cited by 14
Endoscopic ultrasound guided drainage of pancreatic fluid collections: Assessment of the procedure, technical details and review of the literature
Puri, R., Thandassery, R. B., Alfadda, A. A., & Kaabi, S. A. (2015) · World Journal of Gastrointestinal Endoscopy · doi:10.4253/wjge.v7.i4.354 · Cited by 13
Early Predictors of Abdominal Hemorrhage Among Critically Ill Patients With Pancreatitis
Labarca, E., Zubia‐Olaskoaga, F., Maraví-Poma, E., & Martínez, F. T. (2018) · Pancreas · doi:10.1097/mpa.0000000000001135 · Cited by 13
Estimating health state utilities associated with a rare disease: familial chylomicronemia syndrome (FCS)
Matza, L. S., Phillips, G. A., Howell, T. A., Ciffone, N. A., & Ahmad, Z. (2020) · Journal of Medical Economics · doi:10.1080/13696998.2020.1776719 · Cited by 13
Percutaneous biopsy and drainage of the pancreas
Planz, V. B., & Galgano, S. J. (2021) · Abdominal Radiology · doi:10.1007/s00261-021-03244-z · Cited by 13
“MRI can better delineate necrotic debris within collections that is unrecognized by CT (Fig.”
BackgroundInfluential
MicroRNA-361-5p Aggravates Acute Pancreatitis by Promoting Interleukin-17A Secretion via Impairment of Nuclear Factor IA-Dependent Hes1 Downregulation
Song, M., Wang, Y., Zhou, P., Wang, J., Xu, H., & Zheng, J. (2021) · Journal of Medicinal Chemistry · doi:10.1021/acs.jmedchem.1c01110 · Cited by 13
High risk of complications and acute-on-chronic liver failure in cirrhosis patients with acute pancreatitis
Vogel, M., Ehlken, H., Kluge, S., Röesch, T., Lohse, A. W., Huber, S., Sterneck, M. R., & Huebener, P. (2022) · European Journal of Internal Medicine · doi:10.1016/j.ejim.2022.05.034 · Cited by 14
Clinical decision limits as criteria for setting analytical performance specifications for laboratory tests
Rotgers, E., Linko, S., Theodorsson, E., & Kouri, T. (2023) · Clinica Chimica Acta · doi:10.1016/j.cca.2023.117233 · Cited by 13
Aggressive versus controlled fluid resuscitation in acute pancreatitis: A systematic review and meta-analysis of randomized controlled trials
He, K., Gao, L., Yang, Z., Zhang, Y., Hua, T., Hu, W., Wu, D., & Ke, L. (2023) · Chinese Medical Journal · doi:10.1097/cm9.0000000000002684 · Cited by 13
A novel ROS-Related chemiluminescent semiconducting polymer nanoplatform for acute pancreatitis early diagnosis and severity assessment
Li, Y., Yin, B., Song, Y., Chen, K., Chen, X., Zhang, Y., Yu, N., Peng, C., Zhang, X., Song, G., et al. (2023) · Journal of Nanobiotechnology · doi:10.1186/s12951-023-01937-9 · Cited by 13
The Impact of the COVID-19 Pandemic on Outcomes in Acute Pancreatitis: A Propensity Score Matched Study Comparing before and during the Pandemic
Rădulescu, P. M., Căluianu, E. I., Traşcă, E. T., Mercuţ, D., Georgescu, I., Georgescu, E. F., Ciupeanu-Călugăru, E. D., Mercuț, M. F., Mercuţ, R., Pădureanu, V., et al. (2023) · Diagnostics · doi:10.3390/diagnostics13142446 · Cited by 13
“suggested that both elevated AST and ALT are associated with an increased risk of mortality in patients with AP [54].”
Background
Sensing of Digestive Enzymes—Diagnosis and Monitoring of Pancreatitis
Yin, J., Cui, T., Yan, Z., & Ren, T. (2023) · Chemosensors · doi:10.3390/chemosensors11090469 · Cited by 13
Analysis of Risk Factors for Severe Acute Pancreatitis in the Early Period (<24 h) After Admission
Yang, Q., Gao, Y., Li, Z., Zheng, J., Fu, H. C., & Ma, Y. (2024) · Journal of Emergency Medicine · doi:10.1016/j.jemermed.2024.02.011 · Cited by 13
EASIER trial (Erector-spinAe analgeSia for hepatopancreaticobiliary pain In the Emergency Room): a single-centre open-label cohort-based randomised controlled trial analysing the efficacy of the ultrasound-guided erector-spinae plane block compared with intravenous morphine in the treatment of acute hepatopancreaticobiliary pain in the emergency department
David, S. N., Murali, V., Kattumala, P. D., Abhilash, K. P. P., Thomas, A. J., Chowdury, S. D., & Karuppusami, R. (2024) · Emergency Medicine Journal · doi:10.1136/emermed-2023-213799 · Cited by 13
Artesunate protects against a mouse model of cerulein and lipopolysaccharide‑induced acute pancreatitis by inhibiting TLR4‑dependent autophagy
Liu, D., Liu, C., Ouyang, F., Qin, R., Zhai, Z., Wang, Y., Zhang, Y., Liao, M., Pan, X., Huang, Y.-S., et al. (2024) · International Journal of Molecular Medicine · doi:10.3892/ijmm.2024.5466 · Cited by 13
Successful Resolution of Gastric Outlet Obstruction Caused by Pancreatic Pseudocyst or Walled-Off Necrosis After Acute Pancreatitis
Zhang, Y., Zhang, S.-Y., Gao, S., Liang, Z.-Y., Yu, W.-Q., & Liang, T.-B. (2015) · Pancreas · doi:10.1097/mpa.0000000000000429 · Cited by 11
“It is commonly accepted that asymptomatic and noninfectious PPs or WON does not need interventional treatment.(21) Once GOO appears active, measures including surgery may be necessary, because ineffective intraintestinal nutrition may cause malnutrition and the risk of aspiration pneumonia and intraluminal infection c…”
Background
Opiate Prescriptions at Discharge Are Not Associated with Early Readmissions in Acute Pancreatitis
Yang, A. L., Jin, D. X., Rudder, M., Suleiman, S., Banks, P. A., & McNabb-Baltar, J. Y. (2019) · Digestive Diseases and Sciences · doi:10.1007/s10620-019-05799-w · Cited by 14
Management of Acute Pancreatitis in the Early Stage.
Zărnescu, N. O., Barbu, S. T., Vasiliu, E. C. Z., Costea, R., & Neagu, Ş. I. (2015) · PubMed Central · Cited by 15
Cost of Unnecessary Amylase and Lipase Testing at Multiple Academic Health Systems
Ritter, J. P., Ghirimoldi, F., Manuel, L., Moffett, E., Novicki, T. J., McClay, J. C., Shireman, P. K., & Brimhall, B. B. (2019) · American Journal of Clinical Pathology · doi:10.1093/ajcp/aqz170 · Cited by 13
Pancreatic necrosis and severity are independent risk factors for pancreatic endocrine insufficiency after acute pancreatitis: A long-term follow-up study
Yu, B., Li, N., He, W., He, C., Wan, J., Zhu, Y., & Lü, N. (2020) · World Journal of Gastroenterology · doi:10.3748/wjg.v26.i23.3260 · Cited by 14
Role of endoscopic ultrasonography in the diagnostic work-up of idiopathic acute pancreatitis (PICUS): study protocol for a nationwide prospective cohort study
Umans, D. S., Timmerhuis, H. C., Hallensleben, N. D. L., Bouwense, S. A. W., Anten, M.-P., Bhalla, A., Bijlsma, R., Boermeester, M. A., Brink, M. A., Hol, L., et al. (2020) · BMJ Open · doi:10.1136/bmjopen-2019-035504 · Cited by 13
Hypercalcemia of Malignancy and Acute Pancreatitis
Imam, Z., Hanna, A., Jomaa, D., Khasawneh, M., Abonofal, A., & Murad, M. H. (2021) · Pancreas · doi:10.1097/mpa.0000000000001741 · Cited by 14
“Abdominal pain consistent with AP was defined as epigastric, upper abdominal, or generalized abdominal pain with or without radiation into the back .(6)”
Background
Evaluation of the American Society of Gastrointestinal Endoscopy 2019 and the European Society of Gastrointestinal Endoscopy guidelines' performances for choledocholithiasis prediction in clinically suspected patients: A retrospective cohort study
Tunruttanakul, S., Chareonsil, B., Verasmith, K., Patumanond, J., & Mingmalairak, C. (2022) · JGH Open · doi:10.1002/jgh3.12773 · Cited by 13
Safety and efficacy of intravenous hydromorphone patient-controlled analgesia versus intramuscular pethidine in acute pancreatitis: An open-label, randomized controlled trial
Chen, Z., Jiang, K., Liu, F., Zhu, P., Cai, F., He, Y., Jin, T., Lin, Z., Li, Q., Hu, C., et al. (2022) · Frontiers in Pharmacology · doi:10.3389/fphar.2022.962671 · Cited by 13
“1 Acute pancreatitis treatment All participants received the same treatment (Tenner et al., 2013; Crockett et al., 2018), including fluid resuscitation, nutrition support, organ function support, antibiotics with indications, and surgical intervention, if necessary.”
Background
Drug Therapy for Acute Pancreatitis
Bi, Y., Atwal, T., & Vege, S. S. (2015) · Current Treatment Options in Gastroenterology · doi:10.1007/s11938-015-0058-7 · Cited by 13
Prophylactic Administration of Silybin Ameliorates L-Arginine-Induced Acute Pancreatitis
Uçmak, F., Ekin, N., İbiloğlu, İ., Arslan, S., Kaplan, İ., & Şenateş, E. (2016) · Medical Science Monitor · doi:10.12659/msm.898014 · Cited by 13
Combination of two-hour post-endoscopic retrograde cholangiopancreatography amylase levels and cannulation times is useful for predicting post-endoscopic retrograde cholangiopancreatography pancreatitis
Hayashi, S., Nishida, T., Shimakoshi, H., Shimoda, A., Amano, T., Sugimoto, A., Takahashi, K., Mukai, K., Matsubara, T., Yamamoto, M., et al. (2016) · World Journal of Gastrointestinal Endoscopy · doi:10.4253/wjge.v8.i20.777 · Cited by 13
Assessing the severity of acute pancreatitis (ASAP) in Switzerland: A nationwide survey on severity assessment in daily clinical practice
Staubli, S. M., Oertli, D., & Nebiker, C. A. (2017) · Pancreatology · doi:10.1016/j.pan.2017.02.006 · Cited by 13
Acute Pancreatitis Related to a Chemotherapy Drug
Murtaza, G., Faqah, A., Konowitz, N., Lu, H., Kuruvilla, A., & Adhikari, S. (2017) · World Journal of Oncology · doi:10.14740/wjon1006e · Cited by 13
“Gallstones and alcohol are the most common causes of pancreatitis and account for 75% of the cases but medications can also cause pancreatitis [1, 2].”
Background
Gastrointestinal Disturbances in the Elderly
Baker, N. R., & Blakely, K. K. (2017) · Nursing Clinics of North America · doi:10.1016/j.cnur.2017.04.001 · Cited by 13
Case of familial hyperlipoproteinemia type III hypertriglyceridemia induced acute pancreatitis: Role for outpatient apheresis maintenance therapy
Saleh, M. A., Mansoor, E., & Cooper, G. S. (2017) · World Journal of Gastroenterology · doi:10.3748/wjg.v23.i40.7332 · Cited by 13
Elevated triglycerides level in hospital stay as a risk factor of mortality in patients with severe acute pancreatitis
Wu, Q., Fu, M., Zheng, K., Bo, H., Yang, H., Zhong, X. Z., Liang, G., Xu, Y., Hao, B., Hu, Z. Q., et al. (2018) · PLoS ONE · doi:10.1371/journal.pone.0207875 · Cited by 13
Ward-based Goal-Directed Fluid Therapy (GDFT) in Acute Pancreatitis (GAP) trial: study protocol for a feasibility randomised controlled trial
Froghi, F., Soggiu, F., Ricciardi, F., Gurusamy, K. S., Martín, D., Singh, J., Siddique, S., Eastgate, C., Ciaponi, M. J., McNeil, M., et al. (2019) · BMJ Open · doi:10.1136/bmjopen-2018-028783 · Cited by 13
“Due to the time-dependant nature of this trial, similar to most trauma and emergency surgery studies, a summarised and abbreviated patient information sheet will be provided for patients initially on arrival and they will be subsequently provided with an in-depth version.”
Natural history and profile of selective cytokines in patients of acute pancreatitis with acute kidney injury
Prasada, R., Muktesh, G., Samanta, J., Sarma, P., Singh, S., Arora, S. K., Dhaka, N., Ramachandran, R., Gupta, V., Sinha, S. K., et al. (2020) · Cytokine · doi:10.1016/j.cyto.2020.155177 · Cited by 13
The effect of immunonutrition in patients with acute pancreatitis: a systematic review and meta‐analysis
Zhou, J., Xue, Y., Liu, Y., Li, X., Tong, Z., & Li, W. (2020) · Journal of Human Nutrition and Dietetics · doi:10.1111/jhn.12816 · Cited by 13
Indications for medical antibiotic prophylaxis and potential targets for antimicrobial stewardship intervention: a narrative review
Ιωάννου, Π., Karakonstantis, S., Schouten, J. A., Kostyanev, T., Charani, E., Vlahović–Palčevski, V., & Kofteridis, D. P. (2021) · Clinical Microbiology and Infection · doi:10.1016/j.cmi.2021.10.001 · Cited by 13
Imaging Assessment of Etiology and Severity of Acute Pancreatitis
Bollen, T. L. (2016) · doi:10.3998/panc.2016.31 · Cited by 13
Index Admission Cholecystectomy and Recurrence of Pediatric Gallstone Pancreatitis: Multicenter Cohort Analysis
Abraham, A. S. M., Osei, H., Bajinting, A., Cowles, R. A., Greenspon, J., Hosfield, B. D., Keller, M. S., Landman, M. P., Owens, H., Shaughnessy, M. P., et al. (2022) · Journal of the American College of Surgeons · doi:10.1097/xcs.0000000000000062 · Cited by 13
Pancreatite aguda em pacientes etilistas: revisão narrativa
Gomes, J. D. P., Celestino, I. T. P., Vilella, A. M. C., Chaves, D. D. A., Neri, H. V. N., Guedes, I. H. L., Vasconcelos, R. M., Salgado, R. R., & dos Santos, T. A. (2020) · Revista Eletrônica Acervo Saúde · doi:10.25248/reas.e4223.2020 · Cited by 12
Hypertriglyceridemia induced acute pancreatitis: 4 years’ experience from a tertiary care institute and quick literature review
Kumar, B. G. V., Prasad, K., Singh, D., & Sethy, P. C. (2022) · Journal of Family Medicine and Primary Care · doi:10.4103/jfmpc.jfmpc_1426_21 · Cited by 12
“However, gallstones and heavy alcohol consumption are the most common aetiologies, accounting for up to 40% and 30% cases, respectively.[2] AP owing to hypertriglyceridemia (HTG‐AP) is another well‐known etiology for AP, accounting for nearly 7% of all AP cases.”
Background
Diabetes is an independent predictor of severe acute pancreatitis
Durmuş, E. T., Akdağ, İ., & Yıldız, M. (2022) · Postgraduate Medicine · doi:10.1080/00325481.2022.2105613 · Cited by 12
“AP usually follows a mild and self-limiting course, but severe AP (SAP) may result in organ failure and death may develop in 15% to 20% of cases [9].”
BackgroundMethodInfluential
Controversies in the management of acute pancreatitis: An update
Manrai, M., Dawra, S., Singh, A. K., Jha, D. K., & Kochhar, R. K. (2023) · World Journal of Clinical Cases · doi:10.12998/wjcc.v11.i12.2582 · Cited by 13

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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