| Theme | Management of Acute Pancreatitis Based on the Revised JPN Guidelines | |
|---|---|---|
| Title | Acute Biliary Pancreatitis | |
| Publish Date | 2016/05 | |
| Author | Seiki Kiriyama | Department of Gastroenterology, Ogaki Municipal Hospital |
| Author | Takashi Kumada | Department of Gastroenterology, Ogaki Municipal Hospital |
| Author | Makoto Tanikawa | Department of Gastroenterology, Ogaki Municipal Hospital |
| Author | Yasuhiro Hisanaga | Department of Gastroenterology, Ogaki Municipal Hospital |
| Author | Hidenori Toyota | Department of Gastroenterology, Ogaki Municipal Hospital |
| Author | Akira Kanamori | Department of Gastroenterology, Ogaki Municipal Hospital |
| Author | Toshifumi Tada | Department of Gastroenterology, Ogaki Municipal Hospital |
| Author | Syusuke Kitabatake | Department of Gastroenterology, Ogaki Municipal Hospital |
| Author | Tsuyoki Yama | Department of Gastroenterology, Ogaki Municipal Hospital |
| [ Summary ] | Gallstones are the commonest causes of acute pancreatitis. The clinical practice guidelines present the following management strategy for acute biliary pancreatitis. After the diagnosis of acute pancreatitis, its etiology should be classified as biliary or non‒biliary based on laboratory and imaging investigations. However, diagnosing choledocholithiasis using imaging studies is often difficult, because in many patients with acute biliary pancreatitis, the gallstones are either small or have passed through the ampulla of Vater. Similar to other types of pancreatitis, the initial treatment of biliary pancreatitis is usually conservative, and includes bowel rest, intravenous replacement of fluids and electrolytes, and analgesia. Additionally, treatment of associated biliary tract disease is necessary. Furthermore, it is important to adequately plan the timing of intervention for clearance of gallstones. From reviews of clinical trials and meta‒analyses, the practice guidelines recommend urgent endoscopic retrograde cholangiopancreatography and sphincterotomy (ERCP/ES) only in cases of cholangitis or persistent biliary obstruction. In order to reduce the risk of recurrent acute pancreatitis or other biliary complications, cholecystectomy should be performed after pancreatitis has subsided, if the perioperative risk of the patient is reasonable. | |