Position Paper
Consensus guidelines on severe acute pancreatitis

https://doi.org/10.1016/j.dld.2015.03.022Get rights and content

Abstract

This Position Paper contains clinically oriented guidelines by the Italian Association for the Study of the Pancreas (AISP) for the diagnosis and treatment of severe acute pancreatitis. The statements were formulated by three working groups of experts who searched and analysed the most recent literature; a consensus process was then performed using a modified Delphi procedure. The statements provide recommendations on the most appropriate definition of the complications of severe acute pancreatitis, the diagnostic approach and the timing of conservative as well as interventional endoscopic, radiological and surgical treatments.

Introduction

In 2010, the Italian Association for the Study of the Pancreas (AISP) released practical guidelines for acute pancreatitis (AP) [1] and decided that periodical revisions would be implemented as appropriate. At that time, the guidelines were formulated using the ADAPTE process [2]. Four years later, AISP revised the guidelines, and the Governing Board decided the process should be limited to evaluation of the recent literature on the severe forms of AP, which account for the greatest morbidity and mortality [3].

Section snippets

Methodology

AISP produced the present consensus guidelines considering the characteristics of the Italian National Health System. They are divided into three sections: (1) definitions of the complications of severe AP, together with the related diagnostic procedures, (2) conservative treatment and (3) interventional treatments. The definitions of the complications are substantially derived from those of the recently revised Atlanta classification system [4], [5]. The Governing Board considered this an

What are the minimum hospital prerequisites to care for patients with severe AP?

Statement: The minimal requisites for treating patients with severe AP are the availability of an intensive care unit, interventional radiology and interventional endoscopy.

Evidence level 5, Recommendation grade D

Comment: Specific technical facilities are needed for the adequate management of patients with severe AP, and the presence of a multidisciplinary team is strongly recommended. In addition, similarly as reported in pancreatic surgery, a volume-outcome relationship is also true in the

Conclusions

New guidelines [1], [208], [209], [210], [211], [212], [213], [214], [215], [216], [217], [218] and updates of previous guidelines [100], [106], [113], [219] regarding AP have been published in recent years. Renewed interest in this disease relies mainly on a notable amount of new data from the recent literature with several high quality papers which have contributed to changing some old concepts regarding the natural history of AP, indications for treatment and modalities of treatment. Acute

Conflict of interest

None declared.

Acknowledgements

The authors are grateful to Dr. Ivana Truccolo, executive officer of the Scientific and Patient Library at the CRO-National Cancer Institute, Aviano, for her invaluable support in the literature search.

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