2018-02-07 14:30:21 UTC

Better Manage Acute Pancreatitis to Improve Patient Outcomes

Feb. 7, 2018

New AGA guideline addresses questions on the benefits of goal directed fluid resuscitation, early oral feeding and more.

AGA has a new clinical guideline on the initial management of acute pancreatitis, published in Gastroenterology. In the U.S., acute pancreatitis (AP) is a leading cause of inpatient care among gastrointestinal conditions with more than 275,000 patients hospitalized annually, at an aggregate cost of over $2.6 billion per year. The guideline focuses on patient care within the first 48 to 72 hours of admission when management decisions can alter the course of disease and duration of hospitalization. 

Guideline Recommendations

AGA’s new guideline aims to reduce practice variation and promote high quality and high value care for patients suffering from acute pancreatitis. It addresses questions on the benefits of goal directed fluid resuscitation, early oral feeding, enteral vs. parenteral nutrition, the routine use of prophylactic antibiotics and routine ERCP in all patients with AP. 

The guideline is accompanied by a technical review, a new spotlight (infographic) and a patient companion infographic, which provides key points and important information directly to patients. 

AGA’s recommendations include: 

Statement Strength of Recommendation Quality of Evidence

1A. In patients with acute pancreatitis AGA suggests using goal directed therapy for fluid management.  

Comment: AGA makes no recommendation whether normal saline or ringer’s lactate is used.  

Conditional recommendation Very low quality
1B. In patients with acute pancreatitis, AGA suggests against the use of hydroxyethyl starch (HES) fluids.   Conditional recommendation Very low quality
2. In patients with predicted severe acute pancreatitis and necrotizing pancreatitis, AGA suggests against the use of prophylactic antibiotics. Conditional recommendation Low quality
3. In patients with acute biliary pancreatitis and no cholangitis, AGA suggests against the routine use of urgent ERCP.   Conditional recommendation Low quality
4. In patients with acute pancreatitis, AGA recommends early (within 24 hours) oral feeding as tolerated rather than keeping the patient nil per os (NPO). Strong recommendation Moderate quality
5. In patients with acute pancreatitis and inability to feed orally, AGA recommends enteral rather than parenteral nutrition. Strong recommendation Moderate quality
6. In patients with predicted severe or necrotizing pancreatitis requiring enteral tube feeding, AGA suggests either nasogastric or nasoenteral route.   Conditional recommendation Low quality
7. In patients with acute biliary pancreatitis, AGA recommends cholecystectomy during the initial admission rather than following discharge.   Strong recommendation Moderate quality
8. In patients with acute alcoholic pancreatitis, AGA recommends brief alcohol intervention during admission. Strong recommendation Moderate quality

 

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