Evidence-based Guidelines for the Management of Acute Pancreatitis

October 31, 2012

The paper resulting from the meeting held in conjuntion with the 2012 Joint APA/IAP meeting has been published in Pancreatology.  A full text version is now available.

Meeting Schedule

7:00 – 8:00am Registration & Breakfast
8:00 – 8:05am Welcome, Ashok Saluja, PhD
8:05 – 8:15am Introduction: Methods & Process, Marc Besselink & Jens Werner
8:15 – 8:45am
A. Diagnosis of acute pancreatitis and etiology:  
Reviewers: George Papachristou, Pittsburgh; Vjay Singh, Pittsburgh; Michael Rünzi, Essen
Time manager: Julia Mayerle, Greifswald
Speaker: Vijay Singh
  1. What is the definition of acute pancreatitis (regardless of etiology)?
  2. At admission, what laboratory tests and imaging should be performed to determine the etiology of acute pancreatitis (incl definitions)?
  3. What further investigations are indicated in patients with a first or second episode of idiopathic acute pancreatitis?
8:45 – 9:05am
B. Prognostication/predicting severity
Reviewers: Bechien Wu, Los Angeles; Vikesh Singh, Baltimore; John Windsor, Auckland; Peter Banks, Boston; George Papachristou, Pittsburgh 
Time manager: Santhi Swaroop Vege, Rochester
Speaker: Bechien Wu

4. What is the best score/marker (including cut-off value) to predict severe acute pancreatitis at admission and at 48 hrs?

5. What is the best strategy to score severity of acute pancreatitis during admission?

9:05 – 9:35am
C. Imaging
Reviewers: Thomas Bollen, Nieuwegein; Desiree Morgan, Birmingham; Koenraad Mortele, Boston 
Time manager: Santhi Swaroop Vege, Rochester
Speaker: Thomas Bollen 
  1. What is the indication and timing of the initial CT scan assessment in acute pancreatitis?
  2. What are the indications for follow up scanning (CT/MR)?
  3. What is the optimal CT and MR scan protocol?
 9:35 – 9:55am
D. Fluid therapy
Reviewers: Anubhav Mittal, Auckland; John Windsor, Auckland; Mao En-qiang, Shanghai, Timothy Gardner, Lebanon; Julia Mayerle, Greifswald
Time manager: Santhi Swaroop Vege, Rochester
Speaker: Anubhav Mittal
      9. What is the best fluid to use for initial fluid resuscitation?
      10. What is the optimal fluid infusion rate and response measurement for initial fluid resuscitation?

 10:10 – 11:10am

E. Intensive care management
Reviewers: Julia Mayerle, Greifswald; Colin Johnson, Southampton; Jan de Waele, Gent
Time manager: Hjalmar van Santvoort, Utrecht
Speaker: Julia Mayerle
  1. What are the indications for intensive care unit admission?
  2. What are the indications for referral to a specialist centre?
  3. What are the minimal requirements for a specialist centre?
  4. Can early SIRS/organ failure in acute pancreatitis be prevented?
  5. What is the definition of abdominal compartment syndrome in acute pancreatitis ?
  6. How should abdominal compartment syndrome be treated?

 

11:10 – 11:40am
F. Preventing infectious complications in acute pancreatitis (antibiotics, SDD, probiotics)
Reviewers: Maxim Petrov, Auckland; Patchen Dellinger, Seattle; Marc Besselink; Utrecht; Markus Lerch, Greifswald,
Time manager: Timothy Gardner, Lebanon
Speaker: Markus Lerch 
   17. Is systemic antibiotic prophylaxis effective in preventing infectious complications?
   18. Is selective decontamination effective in preventing infectious complications?
   19. Are probiotics effective in preventing infectious complications?

 11:40 – 12:30pm Lunch

 12:30 – 1:20pm
G. Nutritional support
Reviewers: Maxim Petrov, Auckland; Roland Anderson, Lund; Stephen McClave, Louisville;
Time manager: Timothy Gardner, Lebanon
Speaker: Tim Gardner
  1. When to start oral feeding in patients with predicted mild pancreatitis?
  2. What is the indication for enteral nutrition in acute pancreatitis?
  3. What type of enteral nutrition should be used?
  4. Should enteral nutrition be administered via a nasojejunal or nasogastric route?
  5. What is the role of parenteral nutrition?

 

1:20 – 1:50pm
H. Biliary tract management in biliary pancreatitis
Reviewers: Jimmy (Werner) Hartwig, Heidelberg; Hjalmar van Santvoort, Utrecht; Martin Freeman, Minneapolis; Marco Bruno, Rotterdam; Alejandro Oria, Buenos Aires; Peter Banks, Boston 
Time manager: Julia Mayerle, Greifswald
Speaker: Hjalmar van Santvoort 
  1. What is the indication for ERCP and sphincterotomy early in the course of biliary pancreatitis?
  2. If indicated, what is the optimal timing for ERCP in biliary pancreatitis?
  3. What is the role of MRCP and EUS in biliary pancreatitis?

 

1:50 – 2:20pm
I. Indication for intervention
Reviewers: Marc Besselink, Amsterdam; Timothy Gardner, Lebanon; Hein Gooszen, Nijmegen; Todd Baron, Rochester; Carlos Fernandez-DelCastillo, Boston;
Time manager: Jens Werner, Heidelberg
Speaker: Marc Besselink
  1. What are the indications for intervention in necrotizing pancreatitis?
  2. What is the role of fine needle aspiration to diagnose infected necrosis?
  3. What are the indications for intervention in sterile necrotizing pancreatitis?

 

2:35 – 2:55pm
J. Timing of intervention in necrotizing pancreatitis
Reviewers: Peter Fagenholz, Boston; Santhi Swaroop Vege, Rochester; Marc Besselink, Amsterdam; Jens Werner, Heidelberg; Carlos Fernandez-del Castillo, Boston
Time manager: Hjalmar van Santvoort, Utrecht
Speaker: Marc Besselink 
  1. What is the optimal timing of intervention for suspected or confirmed infected necrosis?
  2. Can subgroups of patients (e.g., symptomatic sterile necrosis, mechanical obstruction) be defined that require early or late intervention?

 

2:55 – 3:25pm
K. Intervention strategy (including percutaneous drainage, minimally invasive, endoscopic transluminal, open necrosectomy)
Reviewers: Hjalmar van Santvoort, Utrecht; Carlos Fernandez-del Castillo, Boston; Todd Baron, Rochester; Karen Horvath, Seattle; Thomas Bollen, Nieuwegein; Koenraad Mortele, Boston; Jens Werner, Heidelberg
Time manager: Martin Freeman, Minneapolis
Speaker: Hjalmar van Santvoort

33. What is the optimal interventional strategy for suspected or confirmed infected necrosis?

34. Should drainage (percutaneous or endoscopic transmural) always be the first step?

35. Can subgroups of patients who require different strategies (including conservative treatment) be defined?

3:25 – 3:55pm
L. Timing of cholecystectomy (or endoscopic sphincerotomy) in mild and severe biliary pancreatitis
Reviewers: Mark van Baal, Nijmegen; William Nealon, Nashville; Timothy Gardner, Lebanon; Julia Mayerle, Greifswald.
Time manager: Santhi Swaroop Vege, Rochester
Speaker: Julia Mayerle  
  1. What is the optimal timing of cholecystectomy after mild biliary pancreatitis?
  2. What is the optimal timing of cholecystectomy after severe biliary pancreatitis?
  3. What is the role of cholecystectomy after endoscopic sphincterotomy?

3:55 – 4:30pm Discussion & Steps to Publication, Hjalmar van Santvoort