개정된 대한췌장담도학회 급성췌장염 임상진료지침: 초기 치료, 영양지원, 회복기 치료 = Revised Clinical Practice Guideline of Korean Pancreatobiliary Association for Acute Pancreatitis: Initial Treatment, Nutritional Support, Convalescent Treatment

다국어 초록 (Multilingual Abstract)

Initial and convalescent treatment of acute pancreatitis (AP) is important in order to improve the prognosis and prevent the recurrence in the patients with AP. Initial intensive treatment includes fluid therapy, pain control, antimicrobial therapy, endoscopic retrograde cholangiopancreatography (ERCP), and nutritional support. Goal-directed therapy is recommended for fluid therapy, and the routine use of prophylactic antibiotics is not recommended. In acute gallstone pancreatitis, urgent ERCP should be performed only in patients with cholangitis or persistent cholestasis. Early oral feeding is advisable as tolerated and enteral feeding via nasogastric or nasojejunal tube appear comparable. In convalescent treatment, cholecystectomy during the initial admission is advisable for mild biliary pancreatitis with gallstone as possible, and treatment against alcohol dependence is considerable for recurrent acute alcoholic pancreatitis. In this review, we recommend practice guidelines for initial treatment, nutritional support, and convalescent treatment.
Korean J Pancreas Biliary Tract 2022;27(1):22-31

참고문헌 (Reference)

1 Vege SS, "initial medical treatment of acute pancreatitis : American Gastroenterological Association Institute technical review" 154 : 1103-1139, 2018

2 Boerma D, "Wait-and-see policy or laparoscopic cholecystectomy after endoscopic sphincterotomy for bile-duct stones : a randomised trial" 360 : 761-765, 2002

3 Schepers NJ, "Urgent endoscopic retrograde cholangiopancreatography with sphincterotomy versus conservative treatment in predicted severe acute gallstone pancreatitis(APEC) : a multicentre randomised controlled trial" 396 : 167-176, 2020

4 Nordback I, "The recurrence of acute alcohol-associated pancreatitis can be reduced : a randomized controlled trial" 136 : 848-855, 2009

5 Reus VI, "The American Psychiatric Association practice guideline for the pharmacological treatment of patients with alcohol use disorder" 175 : 86-90, 2018

6 da Costa DW, "Same-admission versus interval cholecystectomy for mild gallstone pancreatitis(PONCHO) : a multicentre randomised controlled trial" 386 : 1261-1268, 2015

7 Li W, "Safety and efficacy of total parenteral nutrition versus total enteral nutrition for patients with severe acute pancreatitis : a meta-analysis" 46 : 3948-3958, 2018

8 Cho J, "Risk of mortality and hospitalization after post-pancreatitis diabetes mellitus vs type 2 diabetes mellitus : a population-based matched cohort study" 114 : 804-812, 2019

9 Pelli H, "Risk factors for recurrent acute alcohol-associated pancreatitis : a prospective analysis" 43 : 614-621, 2008

10 Isaji S, "Revised Japanese guidelines for the management of acute pancreatitis 2015 : revised concepts and updated points" 22 : 433-445, 2015

11 Mao EQ, "Rapid hemodilution is associated with increased sepsis and mortality among patients with severe acute pancreatitis" 123 : 1639-1644, 2010

12 Isenmann R, "Prophylactic antibiotic treatment in patients with predicted severe acute pancreatitis : a placebocontrolled, double-blind trial" 126 : 997-1004, 2004

13 Kahl S, "Procaine hydrochloride fails to relieve pain in patients with acute pancreatitis" 69 : 5-9, 2004

14 Banks PA, "Practice guidelines in acute pancreatitis" 92 : 377-386, 1997

15 Meng W, "Parenteral analgesics for pain relief in acute pancreatitis : a systematic review" 13 : 201-206, 2013

16 Klar E, "Pancreatic ischaemia in experimental acute pancreatitis : mechanism, significance and therapy" 77 : 1205-1210, 1990

17 Hollemans RA, "Pancreatic exocrine insufficiency following acute pancreatitis : systematic review and study level meta-analysis" 18 : 253-262, 2018

18 Basurto Ona X, "Opioids for acute pancreatitis pain" (7) : CD009179-, 2013

19 Nally DM, "Nasogastric nutrition is efficacious in severe acute pancreatitis : a systematic review and meta-analysis" 112 : 1769-1778, 2014

20 Strate T, "Microcirculatory function and tissue damage is improved after therapeutic injection of bovine hemoglobin in severe acute rodent pancreatitis" 30 : 254-259, 2005

21 Yi F, "Meta-analysis : total parenteral nutrition versus total enteral nutrition in predicted severe acute pancreatitis" 51 : 523-530, 2012

22 Carter R, "Management of infected necrosis secondary to acute pancreatitis : a balanced role for minimal access techniques" 3 : 133-138, 2003

23 Wu BU, "Lactated Ringer's solution reduces systemic inflammation compared with saline in patients with acute pancreatitis" 9 : 710-717, 2011

24 Yokoe M, "Japanese guidelines for the management of acute pancreatitis : Japanese Guidelines 2015" 22 : 405-432, 2015

25 de-Madaria E, "Influence of fluid therapy on the prognosis of acute pancreatitis : a prospective cohort study" 106 : 1843-1850, 2011

26 Klar E, "Impact of microcirculatory flow pattern changes on the development of acute edematous and necrotizing pancreatitis in rabbit pancreas" 39 : 2639-2644, 1994

27 Eckerwall GE, "Immediate oral feeding in patients with mild acute pancreatitis is safe and may accelerate recovery--a randomized clinical study" 26 : 758-763, 2007

28 Working Group IAP/APA Acute Pancreatitis Guidelines, "IAP/APA evidence-based guidelines for the management of acute pancreatitis" 13 (13): e1-e15, 2013

29 Mao EQ, "Fluid therapy for severe acute pancreatitis in acute response stage" 122 : 169-173, 2009

30 Gardner TB, "Fluid resuscitation in acute pancreatitis" 6 : 1070-1076, 2008

31 Singh N, "Evaluation of early enteral feeding through nasogastric and nasojejunal tube in severe acute pancreatitis : a noninferiority randomized controlled trial" 41 : 153-159, 2012

32 Al-Omran M, "Enteral versus parenteral nutrition for acute pancreatitis" 2010 : CD002837-, 2010

33 DiMagno MJ, "Endothelial nitric oxide synthase is protective in the initiation of caerulein-induced acute pancreatitis in mice" 287 : G80-G87, 2004

34 Mouli VP, "Efficacy of conservative treatment, without necrosectomy, for infected pancreatic necrosis : a systematic review and meta-analysis" 144 : 333-340, 2013

35 Peiró AM, "Efficacy and tolerance of metamizole versus morphine for acute pancreatitis pain" 8 : 25-29, 2008

36 Zhao G, "Effects of different resuscitation fluid on severe acute pancreatitis" 19 : 2044-2052, 2013

37 Forgács B, "Effect of fluid resuscitation with and without endothelin A receptor blockade on hemoconcentration and organ function in experimental pancreatitis" 32 : 162-168, 2000

38 Bakker OJ, "Early versus on-demand nasoenteric tube feeding in acute pancreatitis" 371 : 1983-1993, 2014

39 Gurusamy KS, "Early versus delayed laparoscopic cholecystectomy for acute gallstone pancreatitis" (9) : CD010326-, 2013

40 Tse F, "Early routine endoscopic retrograde cholangiopancreatography strategy versus early conservative management strategy in acute gallstone pancreatitis" (5) : CD009779-, 2012

41 Wang MD, "Early goaldirected fluid therapy with fresh frozen plasma reduces severe acute pancreatitis mortality in the intensive care unit" 126 : 1987-1988, 2013

42 Sarr MG, "Early fluid"resuscitation/therapy"in acute pancreatitis : which fluid? What rate? What parameters to gauge effectiveness?" 257 : 189-190, 2013

43 Kumar A, "Early enteral nutrition in severe acute pancreatitis : a prospective randomized controlled trial comparing nasojejunal and nasogastric routes" 40 : 431-434, 2006

44 Acosta JM, "Early ductal decompression versus conservative management for gallstone pancreatitis with ampullary obstruction : a prospective randomized clinical trial" 243 : 33-40, 2006

45 Dellinger EP, "Early antibiotic treatment for severe acute necrotizing pancreatitis : a randomized, double-blind, placebo-controlled study" 245 : 674-683, 2007

46 Cuthbertson CM, "Disturbances of the microcirculation in acute pancreatitis" 93 : 518-530, 2006

47 Mole DJ, "Detailed fluid resuscitation profiles in patients with severe acute pancreatitis" 13 : 51-58, 2011

48 da Costa DW, "Cost-effectiveness of same-admission versus interval cholecystectomy after mild gallstone pancreatitis in the PONCHO trial" 103 : 1695-1703, 2016

49 Italian Association for the Study of the Pancreas(AISP), "Consensus guidelines on severe acute pancreatitis" 47 : 532-543, 2015

50 Windsor AC, "Compared with parenteral nutrition, enteral feeding attenuates the acute phase response and improves disease severity in acute pancreatitis" 42 : 431-435, 1998

51 Sathiaraj E, "Clinical trial : oral feeding with a soft diet compared with clear liquid diet as initial meal in mild acute pancreatitis" 28 : 777-781, 2008

52 Greenberg JA, "Clinical practice guideline : management of acute pancreatitis" 59 : 128-140, 2016

53 Rajkumar N, "Clear liquid diet vs soft diet as the initial meal in patients with mild acute pancreatitis : a randomized interventional trial" 28 : 365-370, 2013

54 Nealon WH, "Appropriate timing of cholecystectomy in patients who present with moderate to severe gallstoneassociated acute pancreatitis with peripancreatic fluid collections" 239 : 741-751, 2004

55 Crockett SD, "American Gastroenterological Association Institute guideline on initial management of acute pancreatitis" 154 : 1096-1101, 2018

56 Tenner S, "American College of Gastroenterology guideline : management of acute pancreatitis" 108 : 1400-1416, 2013

57 Dimagno MJ, "Advances in managing acute pancreatitis" 1 : 59-, 2009

58 Nikkola J, "Abstinence after first acute alcohol-associated pancreatitis protects against recurrent pancreatitis and minimizes the risk of pancreatic dysfunction" 48 : 483-486, 2013

59 Petrov MS, "A systematic review on the timing of artificial nutrition in acute pancreatitis" 101 : 787-793, 2009

60 Eatock FC, "A randomized study of early nasogastric versus nasojejunal feeding in severe acute pancreatitis" 100 : 432-439, 2005

61 Jacobson BC, "A prospective, randomized trial of clear liquids versus low-fat solid diet as the initial meal in mild acute pancreatitis" 5 : 946-886, 2007

62 Moraes JM, "A full solid diet as the initial meal in mild acute pancreatitis is safe and result in a shorter length of hospitalization : results from a prospective, randomized, controlled, double-blind clinical trial" 44 : 517-522, 2010

63 García-Barrasa A, "A double-blind, placebo-controlled trial of ciprofloxacin prophylaxis in patients with acute necrotizing pancreatitis" 13 : 768-774, 2009

64 Dimagno MJ, "A combined paging alert and web-based instrument alters clinician behavior and shortens hospital length of stay in acute pancreatitis" 109 : 306-315, 2014

65 Louie BE, "2004 MacLean-Mueller prize enteral or parenteral nutrition for severe pancreatitis : a randomized controlled trial and health technology assessment" 48 : 298-306, 2005