Acute Pancreatitis Clinical Practice Guidelines (2019)

World Society of Emergency Surgery

This is a quick summary of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

August 01, 2019

In June 2019, the World Society of Emergency Surgery (WSES) released updated guidelines for the management of severe acute pancreatitis (SAP).[1]

Severity Grading

SAP is associated with persistent organ failure (cardiovascular, respiratory, and/or renal) and high mortality. Both new classification systems, Revised Atlanta Classification and Determinant-based Classification of Acute Pancreatitis Severity, are similar in establishing the diagnosis and severity of acute pancreatitis.

Patients with persistent organ failure with infected necrosis have the highest risk of death.

Admit patients with organ failures to an intensive care unit whenever possible.

Diagnostic Laboratory Parameters

The cut-off value of serum amylase and lipase is normally defined as three times the upper limit.

A hematocrit level above 44% is an independent risk factor of pancreatic necrosis.

Imaging

On admission, perform ultrasonography (US) to determine the etiology of acute pancreatitis (biliary).

When doubt exists, computed tomography (CT) scanning provides good evidence of the presence or absence of pancreatitis.

Assess all patients with SAP with contrast-enhanced CT (CE-CT) scanning or magnetic resonance imaging (MRI). Optimal timing for the first CE-CT assessment is 72-96 hours after symptomatic onset.

Consider MR cholangiopancreatography (MRCP) or endoscopic US to screen for occult common bile duct stones in patients with an unknown etiology.

Follow-up imaging

In SAP (CT scan severity index ≥ 3), a follow-up CE-CT scan is indicated 7-10 days from the initial CT scan.

Additional CE-CT scans are recommended only if the patient's clinical status deteriorates or fails to show continued improvement, or when invasive intervention is considered.

Surgical Intervention

The following are indications for surgical intervention:

  • As a continuum in a step-up approach after a percutaneous/endoscopic procedure with the same indications

  • Abdominal compartment syndrome

  • Acute ongoing bleeding when an endovascular approach is unsuccessful

  • Bowel ischemia or acute necrotizing cholecystitis during acute pancreatitis

  • Bowel fistula extending into a peripancreatic collection

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