Acute Pancreatitis

Question 1

We suggest trans-abdominal ultrasound in patient w/ AP to evaluate for biliary pancreatitis and a repeat ultrasound if the initial exam is inconclusive.

Answer 1

conditional, very low evidence

Question 2

In patients w/ IAP, we suggest additional diagnostic evaluation w/ repeat US, MRI and/or EUS.

Answer 2

conditional, very low evidence

Question 3

We suggest using lactated ringer solution over normal saline for IV resuscitation in AP.

Answer 3

conditional, low evidence

Question 4

We suggest medical therapy over early (within 72 hrs) ERCP in acute ciliary pancreatitis w/o cholangitis.

Answer 4

conditional, low evidence

Question 5

We recommend rectal indomethacin to prevent PEP in individuals considered to be at high risk of post-ERCP pancreatitis.

Answer 5

strong, moderate evidence

Question 6

We suggest placement of a pancreatic duct stent in patients at high risk for PEP who are receiving rectal indomethacin.

Answer 6

conditional, low evidence

Question 7

We suggest against prophylactic antibiotics in patients w/ severe AP.

Answer 7

conditional, very low evidence

Question 8

We suggest against FNA in patients w/ suspected infected pancreatic necrosis.

Answer 8

conditional, very low evidence

Question 9

In patients w/ mild AP, we suggest early oral feeding (within 24-48 hr) as tolerated by the patient compared w/ the traditional NPO approach.

Answer 9

conditional, low evidence

Question 10

In patients w/ mild AP, we suggest initial oral feeding w/ low-fat solid diet rather than a stepwise liquid to solid approach.

Answer 10

conditional, low evidence