Evidence Based Management of Acute Biliary Pancreatitis
Evidence Based Management of Acute Biliary Pancreatitis
This study aims to assess the outcome of standardized evidence-based care to all patients
 with acute biliary pancreatitis treated at surgery department, Zagazig University hospitals
 during the period from may, 2017 to may 2019.
Acute pancreatitis (AP) is one of the most important gastrointestinal disorders causing
 emotional and physical human burden . The annual incidence worldwide for AP is 4.9-73.4 cases
 per 100,000 people and the overall mortality rate is 4 to 8%, which increases to 33% in
 patients with infected necrosis. AP is diagnosed when two of three criteria are fulfilled:
 typical abdominal pain of AP, more than three times elevated serum amylase/lipase level and
 signs of AP on imaging.

 It is necessary to clarify the etiology of AP promptly. The diagnosis of gallstones, as the
 leading cause for AP, should have the top priority as that will direct the treatment policy.
 Long standing alcohol consumption and gallstones disease incriminated in the majority of
 cases with AP. Small common bile duct stones, in particular, are the cause of AP in
 approximately 32 to 40% of cases. In 10-30% of cases, the cause is unknown, so studies have
 suggested that up to 70% of cases of idiopathic pancreatitis are secondary to biliary
 microlithiasis.

 The pathogenesis of biliary AP has been intensively investigated. Many theories explain how
 gallstones can trigger AP. The predominant theories include common pathway theory and
 gallstone migration theory. In general, AP occurs when intracellular protective mechanisms
 fail to prevent trypsinogen activation or reduce trypsin activity.

 It is important that management of such potentially life threatening condition to be guided
 by an evidence-based approach. After comparing the Japanese (JPN) Guidelines 2015 and its
 former edition 2010 with the other two guidelines, International Association of
 Pancreatology/American Pancreas Association guidelines (IAP/APA), 2013 and American College
 of Gastroenterology (ACG), 2013, the JPN Guidelines, 2015 proved to be the highest quality
 regarding its systematic literature review prepared by the meta-analysis team, including the
 grading of recommendations and providing pancreatitis bundles.
Inclusion Criteria:

 -  all cases with acute biliary pancreatitis

 Exclusion Criteria:

 -  all cases with non biliary pancreatitis