Initial Management of Acute Pancreatitis

Publication Date: March 1, 2018
Last Updated: December 16, 2022

Treatment

Summary of Recommendations of the AGA Clinical Guideline for the Initial Management of Acute Pancreatitis

In patients with acute pancreatitis, AGA suggests using goal-directed therapy for fluid management. ( Very Low , Conditional (weak) )
Comment: AGA makes no recommendation whether normal saline or ringer’s lactate is used.
612
In patients with acute pancreatitis, AGA suggests against the use of hydroxyethyl starch (HES) fluids. ( Very Low , Conditional (weak) )
612
In patients with predicted severe acute pancreatitis and necrotizing pancreatitis, AGA suggests against the use of prophylactic antibiotics. ( Low , Conditional (weak) )
612
In patients with acute biliary pancreatitis and no cholangitis, AGA suggests against the routine use of urgent ERCP. ( Low , Conditional (weak) )
612
In patients with acute pancreatitis, AGA recommends early (within 24 hours) oral feeding as tolerated rather than keeping the patient NPO. ( Moderate , Strong )
612
In patients with acute pancreatitis and inability to feed orally, AGA recommends enteral rather than parenteral nutrition. ( Moderate , Strong )
612
In patients with predicted severe or necrotizing pancreatitis requiring enteral tube feeding, AGA suggests either nasogastric or nasoenteral route. ( Low , Conditional (weak) )
612
In patients with acute biliary pancreatitis, AGA recommends cholecystectomy during the initial admission rather than following discharge. ( Moderate , Strong )
612
In patients with acute alcoholic pancreatitis, AGA recommends brief alcohol intervention during admission. ( Moderate , Strong )
612

Recommendation Grading

Overview

Title

Initial Management of Acute Pancreatitis

Authoring Organization

American Gastroenterological Association

Publication Month/Year

March 1, 2018

Last Updated Month/Year

November 5, 2024

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

Present the official recommendations of the American Gastroenterological Association (AGA) on the initial management of acute pancreatitis (AP). 

Target Patient Population

Patients with acute pancreatitis

Inclusion Criteria

Male, Female, Adolescent, Adult, Older adult

Health Care Settings

Ambulatory, Emergency care, Outpatient

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Treatment, Management

Diseases/Conditions (MeSH)

D010195 - Pancreatitis, D019283 - Pancreatitis, Acute Necrotizing, D000081032 - Pancreatitis, Acute Hemorrhagic

Keywords

acute pancreatitis, pancreatitis, ERCP

Source Citation

Crockett SD, Wani S, Gardner TB, Falck-Ytter Y, Barkun AN; American Gastroenterological Association Institute Clinical Guidelines Committee. American Gastroenterological Association Institute Guideline on Initial Management of Acute Pancreatitis. Gastroenterology. 2018 Mar;154(4):1096-1101.

Supplemental Methodology Resources

Technical Review