Masamichi Yokoe1, Tadahiro Takada2, Toshihiko Mayumi3, Masahiro Yoshida4, Shuji Isaji5, Keita Wada2, Takao Itoi6, Naohiro Sata7, Toshifumi Gabata8, Hisato Igarashi9, Keisho Kataoka10,11, Masahiko Hirota12, Masumi Kadoya13, Nobuya Kitamura14, Yasutoshi Kimura15, Seiki Kiriyama16, Kunihiro Shirai17, Takayuki Hattori18, Kazunori Takeda19, Yoshifumi Takeyama20, Morihisa Hirota21, Miho Sekimoto22, Satoru Shikata23, Shinju Arata24, Koichi Hirata15. 1. General Internal Medicine, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan. 2. Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan. 3. Department of Emergency Medicine, School of Medicine, University of Occupational and Environmental Health, KitaKyushu, Japan. 4. Department of Hemodialysis and Surgery, Chemotherapy Research Institute, International University of Health and Welfare, Ichikawa, Japan. 5. Hepatobiliary Pancreatic & Transplant Surgery Mie University Graduate School of Medicine, Mie, Japan. 6. Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan. 7. Department of Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan. 8. Department of Radiology, Kanazawa University, School of Medical Science, Kanazawa, Japan. 9. Clinical Education Center, Kyushu University Hospital, Fukuoka, Japan. 10. Otsu Municipal Hospital, Shiga. 11. Kyoto Prefectural University of Medicine, Kyoto, Japan. 12. Department of Surgery, Kumamoto Regional Medical Center, Kumamoto, Japan. 13. Department of Radiology, Shinshu University School of Medicine, Matsumoto, Japan. 14. Department of Emergency and Critical Care Medicine, Kimitsu Chuo Hospital, Kisarazu, Chiba, Japan. 15. Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Sapporo, Japan. 16. Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan. 17. Department of Emergency and Critical Care Medicine, Ichinomiya Municipal Hospital, Ichinomiya, Japan. 18. Department of Radiology, Tokyo Metropolitan Health and Medical Treatment Corporation, Ohkubo Hospital, Tokyo, Japan. 19. Department of Surgery, National Hospital Organization Sendai Medical Center, Sendai, Japan. 20. Department of Surgery, Kinki University Faculty of Medicine, Osaka, Japan. 21. Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan. 22. The University of Tokyo Graduate School of Public Policy, Health Policy Unit, Tokyo. 23. Department of Family Medicine, Mie Prefectural Ichishi Hospital, Mie, Japan. 24. Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan.
Abstract
BACKGROUND: Japanese (JPN) guidelines for the management of acute pancreatitis were published in 2006. The severity assessment criteria for acute pancreatitis were later revised by the Japanese Ministry of Health, Labour and Welfare (MHLW) in 2008, leading to their publication as the JPN Guidelines 2010. Following the 2012 revision of the Atlanta Classifications of Acute Pancreatitis, in which the classifications of regional complications of pancreatitis were revised, the development of a minimally invasive method for local complications of pancreatitis spread, and emerging evidence was gathered and revised into the JPN Guidelines. METHODS: A comprehensive evaluation was carried out on the evidence for epidemiology, diagnosis, severity, treatment, post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis and clinical indicators, based on the concepts of the GRADE system (Grading of Recommendations Assessment, Development and Evaluation). With the graded recommendations, where the evidence was unclear, Meta-Analysis team for JPN Guidelines 2015 conducted an additional new meta-analysis, the results of which were included in the guidelines. RESULTS: Thirty-nine questions were prepared in 17 subject areas, for which 43 recommendations were made. The 17 subject areas were: Diagnosis, Diagnostic imaging, Etiology, Severity assessment, Transfer indication, Fluid therapy, Nasogastric tube, Pain control, Antibiotics prophylaxis, Protease inhibitor, Nutritional support, Intensive care, management of Biliary Pancreatitis, management of Abdominal Compartment Syndrome, Interventions for the local complications, Post-ERCP pancreatitis and Clinical Indicator (Pancreatitis Bundles 2015). Meta-analysis was conducted in the following four subject areas based on randomized controlled trials: (1) prophylactic antibiotics use; (2) prophylactic pancreatic stent placement for the prevention of post-ERCP pancreatitis; (3) prophylactic non-steroidal anti-inflammatory drugs (NSAIDs) for the prevention of post-ERCP pancreatitis; and (4) peritoneal lavage. Using the results of the meta-analysis, recommendations were graded to create useful information. In addition, a mobile application was developed, which made it possible to diagnose, assess severity and check pancreatitis bundles. CONCLUSIONS: The JPN Guidelines 2015 were prepared using the most up-to-date methods, and including the latest recommended medical treatments, and we are confident that this will make them easy for many clinicians to use, and will provide a useful tool in the decision-making process for the treatment of patients, and optimal medical support. The free mobile application and calculator for the JPN Guidelines 2015 is available via http://www.jshbps.jp/en/guideline/jpn-guideline2015.html.
BACKGROUND: Japanese (JPN) guidelines for the management of acute pancreatitis were published in 2006. The severity assessment criteria for acute pancreatitis were later revised by the Japanese Ministry of Health, Labour and Welfare (MHLW) in 2008, leading to their publication as the JPN Guidelines 2010. Following the 2012 revision of the Atlanta Classifications of Acute Pancreatitis, in which the classifications of regional complications of pancreatitis were revised, the development of a minimally invasive method for local complications of pancreatitis spread, and emerging evidence was gathered and revised into the JPN Guidelines. METHODS: A comprehensive evaluation was carried out on the evidence for epidemiology, diagnosis, severity, treatment, post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis and clinical indicators, based on the concepts of the GRADE system (Grading of Recommendations Assessment, Development and Evaluation). With the graded recommendations, where the evidence was unclear, Meta-Analysis team for JPN Guidelines 2015 conducted an additional new meta-analysis, the results of which were included in the guidelines. RESULTS: Thirty-nine questions were prepared in 17 subject areas, for which 43 recommendations were made. The 17 subject areas were: Diagnosis, Diagnostic imaging, Etiology, Severity assessment, Transfer indication, Fluid therapy, Nasogastric tube, Pain control, Antibiotics prophylaxis, Protease inhibitor, Nutritional support, Intensive care, management of Biliary Pancreatitis, management of Abdominal Compartment Syndrome, Interventions for the local complications, Post-ERCP pancreatitis and Clinical Indicator (Pancreatitis Bundles 2015). Meta-analysis was conducted in the following four subject areas based on randomized controlled trials: (1) prophylactic antibiotics use; (2) prophylactic pancreatic stent placement for the prevention of post-ERCP pancreatitis; (3) prophylactic non-steroidal anti-inflammatory drugs (NSAIDs) for the prevention of post-ERCP pancreatitis; and (4) peritoneal lavage. Using the results of the meta-analysis, recommendations were graded to create useful information. In addition, a mobile application was developed, which made it possible to diagnose, assess severity and check pancreatitis bundles. CONCLUSIONS: The JPN Guidelines 2015 were prepared using the most up-to-date methods, and including the latest recommended medical treatments, and we are confident that this will make them easy for many clinicians to use, and will provide a useful tool in the decision-making process for the treatment of patients, and optimal medical support. The free mobile application and calculator for the JPN Guidelines 2015 is available via http://www.jshbps.jp/en/guideline/jpn-guideline2015.html.
Authors: Bernardo Calamo-Guzman; Luis De Vinatea-Serrano; Alejandro Piscoya Journal: United European Gastroenterol J Date: 2018-01-11 Impact factor: 4.623