Isaji Shuji, Takada Tadahiro, Mayumi Toshihiro, Yoshida Masahiro, Wada Keita, Yokoe Masamichi, Itoi Takao, Gabata Toshifumi
Hepatobiliary Pancreatic & Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan.
J Hepatobiliary Pancreat Sci. 2015 Jun;22(6):433-45. doi: 10.1002/jhbp.260.
Taking together the recent dramatic changes of the revised Atlanta classification and evidence newly obtained such as the role of step-up approach for necrotizing pancreatitis, the revision committee of the Japanese (JPN) Guidelines 2015 was prompted to perform an extensive revision of the guidelines.
The JPN Guidelines 2015 was compared to the former edition 2010, and revision concepts and major revision points were reviewed. We compared the JPN 2015 with the other two guidelines, International Association of Pancreatology (IAP)/American Pancreas Association (APA) 2013 and American College of Gastroenterology (ACG) 2013, in order to clarify the distinct points.
The meta-analysis team conducted a new meta-analysis of four subjects that have been associated with conflicting results. It is apparent that the revised guidelines have been created more systematically and more objectively. As of antibiotics prophylaxis, its use in early phase (within 72 h of onset) for severe acute pancreatitis is recommended in JPN 2015 according to the results of original meta-analysis, whereas the other two guidelines do not recommend its routine use. An approach and management of local complications in necrotizing pancreatitis including infected necrosis are almost similar in the three guidelines. JPN 2015 alone emphasizes the implementation of the pancreatitis bundles that specify the management and treatment within the first 48 h after the onset of severe acute pancreatitis.
The JPN Guidelines 2015 prove to be the highest quality in terms of systematic literature review conducting original analyses by the meta-analysis team, determining the grading of recommendations and providing pancreatitis bundles.
鉴于修订后的亚特兰大分类法近期发生的重大变化以及新获得的证据，如逐步治疗法在坏死性胰腺炎中的作用，促使日本（JPN）2015年版指南修订委员会对指南进行全面修订。
将JPN 2015年版指南与2010年的前一版进行比较，并对修订概念和主要修订点进行审查。为明确不同之处，我们将JPN 2015年版指南与另外两个指南，即国际胰腺病协会（IAP）/美国胰腺协会（APA）2013年版和美国胃肠病学会（ACG）2013年版进行了比较。
荟萃分析团队对四个结果存在冲突的主题进行了新的荟萃分析。显然，修订后的指南制定得更加系统、客观。关于抗生素预防，根据原始荟萃分析结果，JPN 2015年版指南建议在重症急性胰腺炎早期（发病72小时内）使用，而另外两个指南不建议常规使用。三个指南中关于坏死性胰腺炎局部并发症（包括感染性坏死）的处理方法和管理几乎相似。只有JPN 2015年版指南强调实施胰腺炎综合治疗方案，该方案明确了重症急性胰腺炎发病后48小时内的管理和治疗措施。
就系统的文献综述而言，JPN 2015年版指南质量最高，该综述由荟萃分析团队进行原始分析、确定推荐分级并提供胰腺炎综合治疗方案。
