In a clinical guideline issued by the American College of Gastroenterology and published online in the March issue of the American Journal of Gastroenterology, evidence-based recommendations are presented for the management of patients with acute pancreatitis (AP).
Scott Tenner, M.D., M.P.H., from the State University of New York in Brooklyn, and colleagues discussed management of AP, defined as acute inflammation of the pancreas.
The authors note that AP is heterogeneous and progresses differently among patients. Most patients experience symptoms lasting a few days, but about 20 percent will experience complications including pancreatic necrosis and/or organ failure. To assess for biliary pancreatitis, transabdominal ultrasound is suggested for patients with AP; additional diagnostic evaluation is suggested for patients with idiopathic AP. Moderately aggressive fluid resuscitation is suggested for patients. Lactated Ringer solution is recommended over normal saline for intravenous resuscitation. In acute biliary pancreatitis without cholangitis, medical therapy is suggested over early endoscopic retrograde cholangiopancreatography. It is recommended that patients with severe AP should not receive prophylactic antibiotics. Patients with suspected infected pancreatic necrosis are not suggested to undergo fine needle aspiration. Early oral feeding (within 24 to 48 hours) is suggested for patients with mild AP as tolerated by the patient compared with the traditional nothing-by-mouth approach. Initial oral feeding with a low-fat solid diet is recommended for mild AP rather than a stepwise liquid-to-solid approach.
“Although further study is needed, the concept that urgent surgery is required in patients found to have infected necrosis is no longer valid,” the authors write.
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