Gaps and uncertainties in the management of acute pancreatitis: a scoping review and quality assessment of clinical practice guidelines.

BACKGROUND

Universal health coverage (UHC) emphasises equitable care for all, without financial hardships and healthcare professionals use clinical practice guidelines (CPGs) to inform service delivery. With rising burden of acute pancreatitis worldwide, the recent James Lind Alliance highlighted knowledge gaps exist within current pathways. This scoping review and quality assessment aims to determine gaps and uncertainties in CPGs for the management of acute pancreatitis.

METHODS

We conducted a scoping review, through a Arksey and O'Malley five-staged process. Electronic databases (MEDLINE, Embase, CINAHL, PsycINFO), targeted websites, and reference lists were used to identify eligible CPGs on acute pancreatitis on February 22, 2024, and updated on March 27, 2025. Drawing from the UHC effective coverage framework, we mapped twelve indicators to a matrix representing health service types (i.e., promotion, prevention, treatment, rehabilitation). Corresponding strength and quality of each recommendation were extracted and quality of overall CPGs was assessed using AGREE-II.

FINDINGS

Of 22 CPGs identified, 11 were published over the past decade and 17 (77.3%) were from high income countries only. Only two guidelines included experts in rehabilitation and policymakers. 718 recommendations were made and reported across: (i) prevention (n = 3; 2 studies); (ii) treatment (n = 696; 22 studies); and (iii) rehabilitation (n = 19; 4 studies). There were no recommendations made around promotion or palliation. Of the twelve indicators, only obesity prevention or weight management were not covered in any of the guidelines. Within the treatment domain, majority of recommendations focussed on early in-hospital management (n = 215, 30.9%). Of these 337 (48.4%) were graded as strong, but only 125 were (17.9%) were supported by high-level evidence. There were 19 recommendations on rehabilitation across two indicators, which were follow-up care (n = 17) and diagnosis and management of new long-term conditions (n = 2). Of these recommendations, 325 (49.7%) were strong, 27 (4.1%) were moderate, and 171 (26.1%) were weak recommendations, respectively. However, only 109 (16.7%) recommendations were supported by high-level evidence and the majority (n = 230, 35.2%) had moderate-level evidence.

INTERPRETATION

Recommendations on care of AP focus on the in-hospital management, with limited supporting recovery or rehabilitation after acute pancreatitis. Although quality of guidelines has improved over time, discrepancies exist between strength of recommendations and quality of evidence across these domains. Inequity around clinical guidance for promotion, prevention and rehabilitation in patients, serves as a call to action for research to improve long-term outcomes for these patients, aligned to global priorities.

FUNDING

SK was funded by the NIHR Doctoral Research Fellowship (NIHR303288). The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the UK government. The funders had no role in study design, data collection, data analysis, data interpretation, writing of the report, or the decision to submit the paper for publication.