UK guidelines for the management of acute pancreatitis
- UK Working Party on Acute Pancreatitis
- Correspondence to:
MrC D Johnson
University Surgical Unit, Mail Point 816, Southampton General Hospital, Southampton BH24 4EW, UK;
- BSG, British Society of Gastroenterology
- CT, computed tomography
- EUS, endoscopic ultrasound
- MR, magnetic resonance
- MRCP, magnetic resonance cholangiopancreatography
- ERCP, endoscopic retrograde cholangiopancreatography
- FNA, fine needle aspiration
1.0 REVISED RECOMMENDATIONS AND AUDIT STANDARDS
1.1 Recommendations 2003 (*Unchanged from the 1998 recommendations)
*The correct diagnosis of acute pancreatitis should be made in all patients within 48 hours of admission (recommendation grade C).
The aetiology of acute pancreatitis should be determined in at least 80% of cases and no more than 20% should be classified as idiopathic (recommendation grade B).
Although amylase is widely available and provides acceptable accuracy of diagnosis, where lipase estimation is available it is preferred for the diagnosis of acute pancreatitis (recommendation grade A).
Where doubt exists, imaging may be used: ultrasonography is often unhelpful and pancreatic imaging by contrast enhanced computed tomography provides good evidence for the presence or absence of pancreatitis (recommendation grade C).
The definitions of severity, as proposed in the Atlanta criteria, should be used. However, organ failure present within the first week, which resolves within 48 hours, should not be considered an indicator of a severe attack of acute pancreatitis (recommendation grade B).
Available prognostic features which predict complications in acute pancreatitis are clinical impression of severity, obesity, or APACHE II>8 in the first 24 hours of admission, and C reactive protein >150 mg/l, Glasgow score 3 or more, or persisting organ failure after 48 hours in hospital (recommendation grade B).
Patients with persisting organ failure, signs of sepsis, or deterioration in clinical status 6–10 days after admission will require computed tomography (recommendation grade B).
Prevention of complications
The evidence to enable a recommendation about antibiotic prophylaxis against infection of pancreatic necrosis is conflicting and difficult to interpret. Some trials show benefit, others do not. At present there is no consensus on this issue.
If antibiotic prophylaxis is used, it should be given for a maximum of 14 days (recommendation grade B). Further studies are needed (recommendation grade C).
The evidence is not conclusive to support the use of enteral nutrition in all patients with severe acute …