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Objective: The population of Latin America harbors the highest incidence of gallstones and acute biliary pancreatitis, yet little is known about the initial management of acute pancreatitis in this large geographic region., Participants and Methods: We performed a post hoc analysis of responses from physicians based in Latin America to the international multidisciplinary survey on the initial management of acute pancreatitis. The questionnaire asked about management of patients during the first 72h after admission, related to fluid therapy, prescription of prophylactic antibiotics, feeding and nutrition, and timing of cholecystectomy. Adherence to clinical guidelines in this region was compared with the rest of the world., Results: The survey was completed by 358 participants from 19 Latin American countries (median age, 39 years [33-47]; women, 27.1%). The proportion of participants in Latin America vs. the rest of the world who chose non-compliant options with clinical guidelines were: prescription of fluid therapy rate other than moderate (42.2% vs 34.3%, P=.02); prescription of prophylactic antibiotics for severe (10.6% vs 18.0%, P=.002), necrotizing (28.5% vs 36.9%, P=.008), or systemic inflammatory response syndrome-associated (21.2% vs 30.6%, P=.002) acute pancreatitis; not starting an oral diet to patients with oral tolerance (77.9% vs 71.1%, P=.02); and delayed cholecystectomy (16.2% vs 33.8%, P<.001)., Conclusions: Surveyed physicians in Latin America are less likely to prescribe antibiotics and to delay cholecystectomy when managing patients in the initial phase of acute pancreatitis compared to physicians in the rest of the world. Feeding and nutrition appear to require the greatest improvement., (Copyright © 2023 Elsevier España, S.L.U. All rights reserved.)

This article summarizes the clinical practice guideline (CPG) for the management of acute pancreatitis in the Social Security of Peru (EsSalud), to provide evidence-based clinical recommendations for the management of acute pancreatitis in EsSalud. A guideline development group (GEG) was formed that included medical specialists and methodologists. The GEG formulated 7 clinical questions to be answered by this CPG. Systematic searches of systematic reviews and -when considered relevant- primary studies were carried out in PubMed during 2022. The evidence was selected to answer each of the clinical questions posed. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. In periodic work meetings, the GEG used the GRADE methodology to review the evidence and formulate the recommendations, the points of good clinical practice, and the corresponding flow charts. Finally, the CPG was approved with Resolution No. 105-IETSI-ESSALUD-2022. This CPG addressed 7 clinical questions on fluid therapy, start of enteral nutrition, analgesia, type of nutrition, antibiotic, and surgical treatment. Based on these questions, 8 recommendations (1 strong and 7 conditional), 13 BPCs, and 1 flowchart were formulated. This article summarizes the methodology and evidence-based conclusions of the CPG for the management of acute pancreatitis in EsSalud.

Background: Fluid therapy plays a critical role in the management of acute pancreatitis. Normal saline (NS) is commonly used in these patients. However, Lactate Ringer's (LR) has also been shown to be useful for this condition., Aim: To assess the effect of LR compared to NS in patients with acute pancreatitis., Methods: We searched in three electronic databases from inception to December 2020 for randomized controlled trials (RCTs). Outcomes were mortality, intensive care unit (ICU) admission, hospital stay, and Systemic Inflammatory Response Syndrome (SIRS) at 24, 48, and 72 h. The risk of bias was assessed using the Risk of Bias 2.0 tool. All meta-analyses were performed using a random-effects model., Results: Four RCTs comprising 248 patients were included. The mean age ranged from 42.3 to 63.8 years and 49% of patients were men. Patients treated with LR had similar risk of mortality (risk ratio [RR], 0.53; 95% confidence interval [CI], 0.09-3.00) and SIRS at 24 h (RR, 0.69; 95% CI, 0.32-1.51), 48 h (RR, 0.80; 95% CI, 0.46-1.41), and 72 h (RR, 0.68; 95% CI, 0.37-1.25) compared to NS. LR had significantly lower hospital stay (mean difference, - 1.10; 95% CI, - 1.92 to - 0.28) and lower risk of ICU admission (RR, 0.42; 95% CI, 0.20-0.89) compared to NS. The risk of bias was low in nearly all RCTs., Conclusion: No differences were found in the mortality and SIRS at 24, 48, and 72 h in patients treated with LR and NS. In contrast, patients who received LR had a lower risk of ICU admission and lower hospital stay than NS., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)