Evidence-based clinical practice guidelines for acute pancreatitis: proposals |
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| Authors: | Mayumi Toshihiko Ura Hideki Arata Shinjyu Kitamura Nobuya Kiriyama Ikuo Shibuya Kazuhiko Sekimoto Miho Nago Naoki Hirota Masahiko Yoshida Masahiko Ito Yasuo Hirata Koichi Takada Tadahiro;Working Group for the Practical Guidelines for Acute Pancreatitis Japanese Society of Emergency Abdominal Medicine |
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| Institution: | (1) Department of Emergency Medicine and Intensive Care, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8560, Japan, JP;(2) Department of Traumatology and Critical Care Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan, JP;(3) Critical Care Emergency Center, Yokohama City University School of Medicine, Yokohama, Japan, JP;(4) Department of Emergency and Critical Care Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan, JP;(5) Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan, JP;(6) Division of Gastroenterological Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan, JP;(7) Department of General Medicine, Kyoto University School of Medicine, Kyoto, Japan, JP;(8) Tsukude National Health Insurance Clinic, Minami-Shitara, Japan, JP;(9) Second Department of Surgery, Kumamoto University Medical School, Kumamoto, Japan, JP;(10) Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan, JP;(11) Department of Pediatric Surgery, Kyorin University School of Medicine, Mitaka, Tokyo, Japan, JP;(12) First Department of Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan, JP |
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| Abstract: | Background/Purpose: To provide a framework for clinicians to manage acute pancreatitis, evidence-based guidelines have been developed by the
Japanese Society of Abdominal Emergency Medicine.
Methods: Evidence was collected by a systematic search of MEDLINE and Japana Centra Revuo Medicina. A total of 1348 papers were reviewed
and levels of evidence were assessed. Practical recommendations were also graded.
Results: The present guidelines consist of introductions, a summary of recommendations, practice algorithms, definitions, epidemiology,
diagnosis, severity assessment, and therapy. The main points of recommendation in these guidelines are: (1) measuring lipase
for the diagnosis of acute pancreatitis (recommendation grade RG], A). (2) The Severity of acute pancreatitis should be assessed
using a scoring system, such as that of the Japanese Ministry of Health and Welfare or Acute Physiology and Chronic Health
Evaluation (APACHE) II (RG, A). (3) Enhanced computed tomography (CT) should be used for assessment of degree of pancreatic
necrosis and inflammation (RG, B). (4) Prophylactic antibiotic administration should be used for severe pancreatitis (RG,
A), but not for mild to moderate pancreatitis (RG, D). (5) Gabexate mesilate should be used for severe pancreatitis (RG, B).
(6) Enteral feeding should be used for all pancreatitis (RG, B). (7) Continuous hemodiafiltration and continuous arterial
infusion of proteinase inhibitor and antibiotics may be of benefit (RG, C). (8) Fine-needle aspiration should be done for
the diagnosis of infectious pancreatic necrosis, and if positive, necrosectomy is indicated (RG, A).
Conclusions: These guidelines provide useful information for physicians to manage this troublesome disease.
Received: May 6, 2002 / Accepted: May 17, 2002
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ID="*" Working Group for the Practical Guidelines for Acute Pancreatitis of the Japanese Society of Emergency Abdominal Medicine
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ID="**" President of the Japanese Society of Emergency Abdominal Medicine, Tokyo, Japan
Offprint requests to: T. Mayumi |
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| Keywords: | Evidence-based medicine Acute pancreatitis Guidelines Recommendation Scoring system |
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