title: Revised Japanese guidelines for the management of acute pancreatitis 2015: revised concepts and updated points.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Hepatobiliary Pancreatic & Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
authors.forename: Shuji
authors.initials: S
authors.lastname: Isaji
authors.affiliation: Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan.
authors.forename: Tadahiro
authors.initials: T
authors.lastname: Takada
authors.affiliation: Department of Emergency Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Mayumi
authors.affiliation: Department of Hemodialysis and Surgery, Chemotherapy Research Institute, International University of Health and Welfare, Ichikawa, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yoshida
authors.affiliation: Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan.
authors.forename: Keita
authors.initials: K
authors.lastname: Wada
authors.affiliation: General Internal Medicine, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan.
authors.forename: Masamichi
authors.initials: M
authors.lastname: Yokoe
authors.affiliation: Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Itoi
authors.affiliation: Department of Radiology, School of Medical Science, Kanazawa University, Kanazawa, Japan.
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Gabata
mesh_terms: D019468:Disease Management; D006801:Humans; D007564:Japan; D019283:Pancreatitis, Acute Necrotizing / Q000628:therapy*; D017410:Practice Guidelines as Topic / Q000592:standards*
keywords: Enteral nutrition; Pancreatitis bundles; Post-endoscopic retrograde cholangiopancreatography pancreatitis; Prophylactic antibiotics; Therapeutic intervention