特集名 | 急性膵炎―診療ガイドラインの改訂を受けて | |
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題名 | 急性膵炎診療新ガイドライン―改訂の経緯と骨子 | |
発刊年月 | 2016年 05月 | |
著者 | 真弓 俊彦 | 産業医科大学医学部救急医学講座 |
著者 | 金澤 綾子 | 産業医科大学医学部救急医学講座 |
著者 | 岩瀧 麻衣 | 産業医科大学医学部救急医学講座 |
著者 | 大坪 広樹 | 産業医科大学医学部救急医学講座 |
著者 | 古屋 智規 | 産業医科大学医学部救急医学講座 |
【 要旨 】 | 「急性膵炎診療ガイドライン」は2003年に本邦初のEBMの手法に則って作成されたガイドラインであり,その後2回改訂され,今回は2014年4月から10カ月かけてGRADE systemを用いて作成され,2015年3月に改訂出版された.膵局所合併症の定義やその対処法の推奨が変わり,新たにシステマティックレビューを行い,重症膵炎/壊死性膵炎での抗菌薬予防投与が推奨された.早期経腸栄養についてより詳細に記載され,abdominal compartment syndromeの診断や治療法も新たに推奨された.Pancreatitis Bundlesやモバイルアプリも作成されたため,それらを利用し,bundleを遵守することが望まれる. |
Theme | Management of Acute Pancreatitis Based on the Revised JPN Guidelines | |
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Title | Japanese Guidelines for the Management of Acute Pancreatitis 2015 : Revision Process and Points | |
Author | Toshihiko Mayumi | Department of Emergency Medicine, School of Medicine, University of Occupational and Environmental Health |
Author | Ayako Kanazawa | Department of Emergency Medicine, School of Medicine, University of Occupational and Environmental Health |
Author | Mai Iwataki | Department of Emergency Medicine, School of Medicine, University of Occupational and Environmental Health |
Author | Hiroki Otsubo | Department of Emergency Medicine, School of Medicine, University of Occupational and Environmental Health |
Author | Tomoki Furuya | Department of Emergency Medicine, School of Medicine, University of Occupational and Environmental Health |
[ Summary ] | Following the revision of the Atlanta classifications of acute pancreatitis in 2012, in which the classifications of regional complications of pancreatitis were revised, there was development of a minimally invasive method for the treatment of local complications of pancreatitis. Hence, emerging evidence regarding the treatment was gathered, and incorporated into the revision of the Japanese (JPN) guidelines for the management of acute pancreatitis 2015. A comprehensive evaluation was performed on the evidence of epidemiology, diagnosis, severity, and treatment of acute pancreatitis and on data regarding post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis and pancreatitis bundles based on the concepts of the Grading of Recommendations Assessment, Development, and Evaluation system. With the graded recommendations, if the evidence was unclear, the meta-analysis team of the JPN guidelines 2015 conducted a new metaanalysis, and the results of this meta-analysis were included in the guidelines. The meta-analysis was conducted in the following 4 subject areas based on randomized controlled trials : (1) pro-phylactic antibiotics use ; (2) prophylactic pancreatic stent placement for the prevention of post-ERCP pancreatitis ; (3) prophylactic non-steroidal anti-inflammatory drugs for the prevention of post-ERCP pancreatitis ; (4) peritoneal lavage. From the results of the meta-analysis, the recommendations were graded to generate useful information. In addition, a mobile application was developed, which made it possible to diagnose, to assess the severity, and to check pancreatitis bundles. The free mobile application for the JPN guidelines 2015 is available via http://www.jshbps.jp/en/guideline/jpn-guideline2015.html |