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

Indications for emergent ERCP

Routine endoscopic retrograde cholangiopancreatography (ERCP) with acute gallstone pancreatitis is not indicated.

ERCP in patients with acute gallstone pancreatitis and cholangitis is indicated.

Surgical strategies

Infected pancreatic necrosis: Percutaneous drainage as the first-line treatment (step-up approach) delays the surgical treatment to a more favorable time or results in complete resolution of the infection in 25-60% of patients; it is recommended as the first line of treatment.

Minimally invasive surgical strategies (transgastric endoscopic necrosectomy, video-assisted retroperitoneal debridement [VARD]): These result in less postoperative new-onset organ failure but require more interventions.

Mortality: There is insufficient evidence to support an open surgical, mini-invasive, or endoscopic approach.

Timing of cholecystectomy

Laparoscopic cholecystectomy during the index admission is recommended in mild acute gallstone pancreatitis.

When ERCP and sphincterotomy are performed during the index admission, the risk for recurrent pancreatitis is reduced; but same admission cholecystectomy is still advised owing to an increased risk for other biliary complications.

Open Abdomen

Clinicians should be cautious not to over-resuscitate patients with early SAP and to regularly measure intra-abdominal pressure.

Avoid the open abdomen if other strategies can be used to mitigate or treat severe intra-abdominal hypertension (IAH) in SAP.

It is recommended not to use the open abdomen after necrosectomy for SAP (unless severe IAH mandates open abdomen as a mandatory procedure).

It is recommend not to debride or undertake early necrosectomy if forced to undertake an early open abdomen due abdominal compartment syndrome or visceral ischemia.

The use of negative pressure peritoneal therapy is recommended for open abdomen management.

Timing for abdominal closure

Early fascial and/or abdominal definitive closure should be the strategy for management of the open abdomen once any requirements for ongoing resuscitation have ceased, the source control has been definitively reached, no concern regarding intestinal viability persist, no further surgical reexploration is needed, and there are no concerns for abdominal compartment syndrome.

For more information, please go to Acute Pancreatitis and Acute Pancreatitis Imaging.

For more Clinical Practice Guidelines, please go to Guidelines.

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