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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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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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