Diagnosis, objective assessment of severity, and management of acute pancreatitis. Santorini consensus conference.
BACKGROUND
The diagnosis, early assessment, and management of severe acute pancreatitis remain difficult clinical problems. This article presents the consensus obtained at a meeting convened to consider the evidence in these areas. The aim of the article is to provide outcome statements to guide clinical practice, with an assessment of the supporting evidence for each statement.


METHODS
Working groups considered the published evidence in the areas of diagnosis, assessment of severity, nonoperative treatment, and surgical treatment of severe acute pancreatitis. Outcome statements were defined to summarize the conclusions on each point considered. The findings were discussed and agreed on by all participants. A careful assessment was made of the strength of the available evidence (proven, probable, possible, unproven, or inappropriate).


CONCLUSIONS
There is reliable evidence to support much current practice. Clear guidance can be given in most areas examined, and several areas were identified where further investigation would be helpful. Diagnosis using plasma concentrations of pancreatic enzymes is reliable. Rapid advances are taking place in the assessment of severity. Several new therapeutic strategies show real promise for the reduction of morbidity and mortality rates. Surgical debridement is required for infected pancreatic necrosis, but is less often necessary for sterile necrosis.
Dervenis
C
C
Konstantopoulion, Agia Olga Hospital, Athens, Greece. Chrisder@otenet.gr
Johnson
C D
CD
Bassi
C
C
Bradley
E
E
Imrie
C W
CW
McMahon
M J
MJ
Modlin
I
I
D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D019468:Disease Management; D004750:Enteral Nutrition; D006801:Humans; D009336:Necrosis; D010195:Pancreatitis / Q000097:blood / Q000175:diagnosis* / Q000517:prevention & control / Q000628:therapy*; D010972:Platelet Activating Factor / Q000037:antagonists & inhibitors; D011237:Predictive Value of Tests; D011379:Prognosis; D011480:Protease Inhibitors / Q000627:therapeutic use; D018570:Risk Assessment; D012720:Severity of Illness Index; D016717:Sphincterotomy, Endoscopic; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D015415:Biomarkers; D010972:Platelet Activating Factor; D011480:Protease Inhibitors