Takada Tadahiro, Isaji Shuji, Mayumi Toshihiko, Yoshida Masahiro, Takeyama Yoshifumi, Itoi Takao, Sano Keiji, Iizawa Yusuke, Masamune Atsushi, Hirota Morihisa, Okamoto Kohji, Inoue Dai, Kitamura Nobuya, Mori Yasuhisa, Mukai Shuntaro, Kiriyama Seiki, Shirai Kunihiro, Tsuchiya Asuka, Higuchi Ryota, Hirashita Teijiro
Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan.
Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Mie, Japan.
J Hepatobiliary Pancreat Sci. 2022 Oct;29(10):1057-1083. doi: 10.1002/jhbp.1146. Epub 2022 Apr 28.
In preparing the Japanese (JPN) guidelines for the management of acute pancreatitis 2021, the committee focused the issues raised by the results of nationwide epidemiological survey in 2016 in Japan.
In addition to a systematic search using the previous JPN guidelines, papers published from January 2014 to September 2019 were searched for the contents to be covered by the guidelines based on the concept of GRADE system.
Thirty-six clinical questions (CQ) were prepared in 15 subject areas. Based on the facts that patients diagnosed with severe disease by both Japanese prognostic factor score and contrast-enhanced computed tomography (CT) grade had a high fatality rate and that little prognosis improvement after 2 weeks of disease onset was not obtained, we emphasized the importance of Pancreatitis Bundles, which were shown to be effective in improving prognosis, and the CQ sections for local pancreatic complications had been expanded to ensure adoption of a step-up approach. Furthermore, on the facts that enteral nutrition for severe acute pancreatitis was not started early within 48 h of admission and that unnecessary prophylactic antibiotics was used in almost all cases, we emphasized early enteral nutrition in small amounts even if gastric feeding is used and no prophylactic antibiotics are administered in mild pancreatitis.
All the members of the committee have put a lot of effort into preparing the extensively revised guidelines in the hope that more people will have a common understanding and that better medical care will be spread.
在制定《2021年日本急性胰腺炎管理指南》时，委员会重点关注了2016年日本全国流行病学调查结果所提出的问题。
除了使用先前的日本指南进行系统检索外，还根据GRADE系统的概念，检索了2014年1月至2019年9月发表的论文，以获取指南涵盖的内容。
在15个主题领域中准备了36个临床问题（CQ）。基于日本预后因素评分和增强计算机断层扫描（CT）分级均诊断为重症的患者死亡率高以及发病2周后预后改善甚微这一事实，我们强调了胰腺炎综合治疗措施的重要性，该措施已被证明对改善预后有效，并且局部胰腺并发症的CQ部分已扩大，以确保采用逐步升级的方法。此外，基于重症急性胰腺炎患者在入院48小时内未尽早开始肠内营养以及几乎所有病例都使用了不必要的预防性抗生素这一事实，我们强调即使采用胃管喂养，轻度胰腺炎患者也应尽早少量进行肠内营养，且不使用预防性抗生素。
委员会的所有成员都为制定这份经过广泛修订的指南付出了巨大努力，希望更多人能达成共识，推广更好的医疗服务。
