Pacreatitis

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UK guidelines for the management of acute pancreatitis
UK Working Party on Acute Pancreatitis Gut 2005;54;1-9 doi:10.1136/gut.2004.057026

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iii1

GUIDELINES

UK guidelines for the management of acute pancreatitis
UK Working Party on Acute Pancreatitis............................................................................................................................... Gut 2005;54(Suppl III):iii1–iii9. doi: 10.1136/gut.2004.057026

1.0 REVISED RECOMMENDATIONS AND AUDIT STANDARDS
1.1 Recommendations 2003 (*Unchanged from the 1998 recommendations)

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Diagnosis

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*The correct diagnosis of acute pancreatitis should be made in all patients within 48 hours of admission (recommendation grade C). The aetiology of acutepancreatitis 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 isoften unhelpful and pancreatic imaging by contrast enhanced computed tomography provides good evidence for the presence or absence of pancreatitis (recommendation grade C).

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dation 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 pancreatitis. However, if nutritional supportis required, the enteral route should be used if that can be tolerated (recommendation grade A). The nasogastric route for feeding can be used as it appears to be effective in 80% of cases (recommendation grade B).

Treatment of gall stones

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Assessment

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The definitions of severity, as proposed in the Atlanta criteria, should be used. However, organ failure present withinthe 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, orpersisting 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).

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Urgent therapeutic endoscopic retrograde cholangiopancreatography (ERCP) should be performed in patients with acute pancreatitis ofsuspected or proven gall stone aetiology who satisfy the criteria for predicted or actual severe pancreatitis, or when there is cholangitis, jaundice, or a dilated common bile duct. The procedure is best carried out within the first 72 hours after the onset of pain. All patients undergoing early ERCP for severe gall stone pancreatitis require endoscopic sphincterotomy whether or not stones are found in...