Clinical practice guideline: management of acute pancreatitis

Clinical practice guideline: management of acute pancreatitis

Can J Surg 2016;59(2):128-140 | PDF

Joshua A. Greenberg, MD; Jonathan Hsu, MD; Mohammad Bawazeer, MD; John Marshall, MD; Jan O. Friedrich, MD; Avery Nathens, MD; Natalie Coburn, MD; Gary R. May, MD; Emily Pearsall, MSc; Robin S. McLeod, MD

Abstract

There has been an increase in the incidence of acute pancreatitis reported worldwide. Despite improvements in access to care, imaging and interventional techniques, acute pancreatitis continues to be associated with significant morbidity and mortality. Despite the availability of clinical practice guidelines for the management of acute pancreatitis, recent studies auditing the clinical management of the condition have shown important areas of noncompliance with evidence-based recommendations. This underscores the importance of creating understandable and implementable recommendations for the diagnosis and management of acute pancreatitis. The purpose of the present guideline is to provide evidence-based recommendations for the management of both mild and severe acute pancreatitis as well as the management of complications of acute pancreatitis and of gall stone–induced pancreatitis.

Résumé

Une hausse de l’incidence de pancréatite aiguë a été constatée à l’échelle mondiale. Malgré l’amélioration de l’accès aux soins et aux techniques d’imagerie et d’intervention, la pancréatite aiguë est toujours associée à une morbidité et une mortalité importantes. Bien qu’il existe des guides de pratique clinique pour la prise en charge de la pancréatite aiguë, des études récentes sur la vérification de la prise en charge clinique de cette affection révèlent des lacunes importantes dans la conformité aux recommandations fondées sur des données probantes. Ces résultats mettent en relief l’importance de formuler des recommandations compréhensibles et applicables pour le diagnostic et la prise en charge de la pancréatite aiguë. La présente ligne directrice vise à fournir des recommandations fondées sur des données probantes pour la prise en charge de la pancréatite aiguë, qu’elle soit bénigne ou grave, ainsi que de ses complications et de celles de la pancréatite causée par un calcul biliaire.


Presented in part at the Canadian Surgery Forum, Sept. 21, 2014, Vancouver, BC.

Accepted for publication Dec. 7, 2015

Acknowledgements: R. McLeod holds the Angelo and Alfredo De Gasperis Chair in Colorectal Cancer and IBD Research. N. Coburn holds the Hanna Family Research Chair in Surgical Oncology. A. Nathens holds the Canada Research Chair in Systems of Trauma Care.

Affiliations: From the Department of Surgery, University of Toronto, Toronto, Ont. (Greenberg, Bawazeer, Nathens, Coburn, Pearsall, McLeod); the Department of Medicine, University of Toronto, Toronto, Ont. (Hsu, Friedrich, May); the Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont. (McLeod); the Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ont. (Bawazeer, Friedrich); the Division of General Surgery, Mount Sinai Hospital, Toronto, Ont. (McLeod); the Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Ont. (Hsu, Pearsall, McLeod); the Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ont. (McLeod); the Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, Ont. (Nathens, Coburn); and the Divisions of Gastroenterology and General Surgery (Marshall) and Critical Care (Friedrich), St. Michael’s Hospital, Toronto, Ont.

Competing interests: None declared.

Contributors: M. Bawazeer, J. Friedrich, A. Nathens, G. May and R. McLeod designed the study. J. Greenberg, J. Hsu, N. Coburn, E. Pearsall and R. McLeod acquired the data, which J. Greenberg, J. Hsu, M. Bawazeer, J. Marshall, J. Friedrich, N. Coburn, G. May and R. McLeod analyzed. J. Greenberg, M. Bawazeer, A. Nathens, G. May and E. Pearsall wrote the article, which all authors reviewed and approved for publication.

DOI: 10.1503/cjs.015015

Correspondence to: R. McLeod, Rm 1612, Cancer Care Ontario, 620 University Ave., Toronto, ON, M5G 2L7; robin.mcleod@cancercare.on.ca