International multidisciplinary survey on the initial management of acute pancreatitis: Perspective of point‐of‐care specialists focused on daily practice

• Published in: Journal of hepato-biliary-pancreatic sciences 2023-03, Vol.30 (3), p.325-337
• Main Authors: Lluís, Nuria, Asbun, Horacio, Besselink, Marc G., Capurso, Gabriele, Garg, Pramod Kumar, Gelrud, Andres, Khannoussi, Wafaa, Lee, Hong Sik, Leppäniemi, Ari, Löhr, Johannes‐Matthias, Mahapatra, Soumya Jagannath, Mancilla, Carla, Santvoort, Hjalmar C, Zapater, Pedro, Lluís, Felix, Madaria, Enrique, Ramia, José Manuel
• Format: Article
• Language: English
• Subjects: Acute Disease; Adult; antibiotic prophylaxis; Cholecystectomy; cholecystectomy timing; feeding and nutrition; Female; fluid therapy; Humans; Male; Pancreatitis; Pancreatitis, Acute Necrotizing; Point-of-Care Systems; Questionnaires; Surveys and Questionnaires; ursodeoxycholic acid
• ISSN: 1868-6974; 1868-6982
• DOI: 10.1002/jhbp.1201

Background The initial management of patients with acute pancreatitis impacts both morbidity and mortality. Point‐of‐care decisions have been reported to differ from clinical guideline recommendations. Methods An online anonymous questionnaire was distributed through scientific associations and social media using REDCap. Multivariable logistic regression was used to identify the characteristics of participants associated with compliance with the recommendations. Results A total of 1054 participants from 94 countries completed the questionnaire; median age (IQR) was 39 (32–47) years; 30.7% were women. Among the participants, 37% opted for nonmoderate flow of i.v. fluid, 31% for fluid type other than Ringer’s lactate; 73.4% were in favor of nil per os to patients who could eat, 75.5% for other than enteral feeding to patients with oral intolerance; 15.5% used prophylactic antibiotic in patients with severe acute pancreatitis, 34.1% in necrotizing acute pancreatitis, and 27.4% in patients with systemic inflammatory response syndrome; 27.8% delayed cholecystectomy after biliary acute pancreatitis. Participants with publications in PubMed on acute pancreatitis showed better compliance (OR, 1.62; 95% CI: 1.15–2.32; P = .007) with recommendations of the clinical guidelines. Conclusions Feeding and nutrition require the greatest improvement efforts, but also the use of prophylactic antibiotics and timing of cholecystectomy should be improved. Lluís et al. conducted the largest survey to date, with 1054 participants from 94 countries, on the initial management (0–72 h) of patients with acute pancreatitis. Feeding and nutrition appear to require the greatest need for wider adoption, but use of prophylactic antibiotics and timing of cholecystectomy should be improved.