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Journal of Hepato-Biliary-Pancreatic Surgery

, Volume 9, Issue 4, pp 413–422 | Cite as

Evidence-based clinical practice guidelines for acute pancreatitis: proposals

  • Toshihiko Mayumi
  • Hideki Ura
  • Shinjyu Arata
  • Nobuya Kitamura
  • Ikuo Kiriyama
  • Kazuhiko Shibuya
  • Miho Sekimoto
  • Naoki Nago
  • Masahiko Hirota
  • Masahiko Yoshida
  • Yasuo Ito
  • Koichi Hirata
  • Tadahiro Takada

Abstract.

Background/Purpose: To provide a framework for clinicians to manage acute pancreatitis, evidence-based guidelines have been developed by the Japanese Society of Abdominal Emergency Medicine.

Methods: Evidence was collected by a systematic search of MEDLINE and Japana Centra Revuo Medicina. A total of 1348 papers were reviewed and levels of evidence were assessed. Practical recommendations were also graded.

Results: The present guidelines consist of introductions, a summary of recommendations, practice algorithms, definitions, epidemiology, diagnosis, severity assessment, and therapy. The main points of recommendation in these guidelines are: (1) measuring lipase for the diagnosis of acute pancreatitis (recommendation grade [RG], A). (2) The Severity of acute pancreatitis should be assessed using a scoring system, such as that of the Japanese Ministry of Health and Welfare or Acute Physiology and Chronic Health Evaluation (APACHE) II (RG, A). (3) Enhanced computed tomography (CT) should be used for assessment of degree of pancreatic necrosis and inflammation (RG, B). (4) Prophylactic antibiotic administration should be used for severe pancreatitis (RG, A), but not for mild to moderate pancreatitis (RG, D). (5) Gabexate mesilate should be used for severe pancreatitis (RG, B). (6) Enteral feeding should be used for all pancreatitis (RG, B). (7) Continuous hemodiafiltration and continuous arterial infusion of proteinase inhibitor and antibiotics may be of benefit (RG, C). (8) Fine-needle aspiration should be done for the diagnosis of infectious pancreatic necrosis, and if positive, necrosectomy is indicated (RG, A).

Conclusions: These guidelines provide useful information for physicians to manage this troublesome disease.

Key words Evidence-based medicine Acute pancreatitis Guidelines Recommendation Scoring system 

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Copyright information

© Springer-Verlag Tokyo 2002

Authors and Affiliations

  • Toshihiko Mayumi
    • 1
  • Hideki Ura
    • 2
  • Shinjyu Arata
    • 3
  • Nobuya Kitamura
    • 4
  • Ikuo Kiriyama
    • 5
  • Kazuhiko Shibuya
    • 6
  • Miho Sekimoto
    • 7
  • Naoki Nago
    • 8
  • Masahiko Hirota
    • 9
  • Masahiko Yoshida
    • 10
  • Yasuo Ito
    • 11
  • Koichi Hirata
    • 12
  • Tadahiro Takada
    • 10
  1. 1. Department of Emergency Medicine and Intensive Care, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8560, JapanJP
  2. 2. Department of Traumatology and Critical Care Medicine, Sapporo Medical University School of Medicine, Sapporo, JapanJP
  3. 3. Critical Care Emergency Center, Yokohama City University School of Medicine, Yokohama, JapanJP
  4. 4. Department of Emergency and Critical Care Medicine, Graduate School of Medicine, Chiba University, Chiba, JapanJP
  5. 5. Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, JapanJP
  6. 6. Division of Gastroenterological Surgery, Tohoku University Graduate School of Medicine, Sendai, JapanJP
  7. 7. Department of General Medicine, Kyoto University School of Medicine, Kyoto, JapanJP
  8. 8. Tsukude National Health Insurance Clinic, Minami-Shitara, JapanJP
  9. 9. Second Department of Surgery, Kumamoto University Medical School, Kumamoto, JapanJP
  10. 10. Department of Surgery, Teikyo University School of Medicine, Tokyo, JapanJP
  11. 11. Department of Pediatric Surgery, Kyorin University School of Medicine, Mitaka, Tokyo, JapanJP
  12. 12. First Department of Surgery, Sapporo Medical University School of Medicine, Sapporo, JapanJP

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