Guideline Watch: Managing Acute Pancreatitis

Educational Objectives

Summary

Guideline Watch: Managing Acute Pancreatitis

Early management of acute pancreatitis (AP) is critical to prevent complications that occur in as many as 20% of hospitalized patients with AP. Experts from the American College of Gastroenterology (ACG) completed a systematic review of the literature and developed the following guidelines for managing AP. Details appear in The American Journal of Gastroenterology (https://doi.org/10.14309/ajg.0000000000002645).

Key Recommendations

All recommendations are conditional with very low or low quality of evidence unless otherwise stated.

• All patients with AP should undergo transabdominal ultrasound for evaluation of biliary pancreatitis. When the cause of AP is unclear after initial laboratory testing and imaging, patients eventually should undergo additional diagnostic evaluation, which might include repeat ultrasound, magnetic resonance imaging, or endoscopic ultrasound.

• Moderately aggressive fluid resuscitation with lactated Ringer’s solution should be started (https://www.jwatch.org/na56421 and Am J Gastroenterol 2023; 118:2258), defined as a bolus of 10 mL/kg followed by infusion of 1.5 mL/kg/hour (https://www.jwatch.org/na55331 and N Engl J Med 2022; 387:989), and additional boluses can be given if a patient has evidence of hypovolemia.

• Medical therapy is preferred over endoscopic retrograde cholangiopancreatography (ERCP) within the first 72 hours for patients who have AP without cholangitis.

• Rectal indomethacin should be given to individuals at high risk for post-ERCP pancreatitis (strong recommendation with moderate-quality evidence).

• Pancreatic duct stents should be used in patients at high risk for post-ERCP pancreatitis who are receiving rectal indomethacin.

• Although antibiotics are critical for patients with infected pancreatic necrosis, fine-needle aspiration should not be performed, and prophylactic antibiotics should not be given to all patients with severe AP.

• Early oral feeding (within 24-48 hours) should begin with a low-fat solid diet (as opposed to liquid) for patients with mild AP.

Our understanding of the optimal management of acute pancreatitis has changed during the past decade. These evidence-based, practical recommendations support evolving trends in treating this patient population.

Andrew S. Parsons, MD, MPH

Readings

Disclosures

Acknowledgements

CME/CE INFO

Accreditation:

The Audio- Digest Foundation is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Audio- Digest Foundation designates this enduring material for a maximum of 0.00 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Audio Digest Foundation is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's (ANCC's) Commission on Accreditation. Audio Digest Foundation designates this activity for 0.00 CE contact hours.

Lecture ID:

JW350916

Expiration:

This CME course qualifies for AMA PRA Category 1 Credits™ for 3 years from the date of publication.

Instructions:

To earn CME/CE credit for this course, you must complete all the following components in the order recommended: (1) Review introductory course content, including Educational Objectives and Faculty/Planner Disclosures; (2) Listen to the audio program and review accompanying learning materials; (3) Complete posttest (only after completing Step 2) and earn a passing score of at least 80%. Taking the course Pretest and completing the Evaluation Survey are strongly recommended (but not mandatory) components of completing this CME/CE course.

Estimated time to complete this CME/CE course:

Approximately 2x the length of the recorded lecture to account for time spent studying accompanying learning materials and completing tests.

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