International multidisciplinary survey on the initial management of acute pancreatitis: perspective of point-of-care specialists focused on daily practice

Lluís, Núria; Asbun, H.; Besselink, M.; Capurso, Gabriele; Garg, Prerna; Gelrud, A.; Khannoussi, W; Lee, H.; Ak, Leppäniemi; Löhr, Jan; Mahapatra, Soumya Jagannath; Mancilla, Carla; Santvoort, H. van; Zapater, Pedro; Lluis, F.; de-Madaria, Enriqué; Ramia, J.M.

doi:10.1016/j.pan.2022.06.055

Cited by 1 publication

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“…Similarly, only 44.7% with ABP (all severity) had early enteral feeding, and 47.7% with mild ABP had early enteral feeding. An international survey on 1054 participants from 94 countries similarly showed that 15.5% of participants administer routine prophylactic antibiotics for AP, and only 26.6% will start patients who did not vomit on early enteral feeding[ 132 ]. As discussed above, there are currently no recommendations for prophylactic antibiotics, and early enteral feeding is recommended due to its protective effect on bowel mucosa integrity and prevents intestinal bacterial translocation.…”

Section: Management Of Non-mild Apmentioning

confidence: 99%

Diagnosis, severity stratification and management of adult acute pancreatitis–current evidence and controversies

Chan¹,

Shelat²

2022

World J Gastrointest Surg

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Acute pancreatitis (AP) is a disease spectrum ranging from mild to severe with an unpredictable natural course. Majority of cases (80%) are mild and self-limiting. However, severe AP (SAP) has a mortality risk of up to 30%. Establishing aetiology and risk stratification are essential pillars of clinical care. Idiopathic AP is a diagnosis of exclusion which should only be used after extended investigations fail to identify a cause. Tenets of management of mild AP include pain control and management of aetiology to prevent recurrence. In SAP, patients should be resuscitated with goal-directed fluid therapy using crystalloids and admitted to critical care unit. Routine prophylactic antibiotics have limited clinical benefit and should not be given in SAP. Patients able to tolerate oral intake should be given early enteral nutrition rather than nil by mouth or parenteral nutrition. If unable to tolerate per-orally, nasogastric feeding may be attempted and routine post-pyloric feeding has limited evidence of clinical benefit. Endoscopic retrograde cholangiopancreatogram should be selectively performed in patients with biliary obstruction or suspicion of acute cholangitis. Delayed step-up strategy including percutaneous retroperitoneal drainage, endoscopic debridement, or minimal-access necrosectomy are sufficient in most SAP patients. Patients should be monitored for diabetes mellitus and pseudocyst.

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Section: Management Of Non-mild Apmentioning

confidence: 99%