title: Japanese guidelines for the management of acute pancreatitis: Japanese Guidelines 2015.
abstract: BACKGROUND
  Japanese (JPN) guidelines for the management of acute pancreatitis were published in 2006. The severity assessment criteria for acute pancreatitis were later revised by the Japanese Ministry of Health, Labour and Welfare (MHLW) in 2008, leading to their publication as the JPN Guidelines 2010. Following the 2012 revision of the Atlanta Classifications of Acute Pancreatitis, in which the classifications of regional complications of pancreatitis were revised, the development of a minimally invasive method for local complications of pancreatitis spread, and emerging evidence was gathered and revised into the JPN Guidelines.
  
  
  METHODS
  A comprehensive evaluation was carried out on the evidence for epidemiology, diagnosis, severity, treatment, post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis and clinical indicators, based on the concepts of the GRADE system (Grading of Recommendations Assessment, Development and Evaluation). With the graded recommendations, where the evidence was unclear, Meta-Analysis team for JPN Guidelines 2015 conducted an additional new meta-analysis, the results of which were included in the guidelines.
  
  
  RESULTS
  Thirty-nine questions were prepared in 17 subject areas, for which 43 recommendations were made. The 17 subject areas were: Diagnosis, Diagnostic imaging, Etiology, Severity assessment, Transfer indication, Fluid therapy, Nasogastric tube, Pain control, Antibiotics prophylaxis, Protease inhibitor, Nutritional support, Intensive care, management of Biliary Pancreatitis, management of Abdominal Compartment Syndrome, Interventions for the local complications, Post-ERCP pancreatitis and Clinical Indicator (Pancreatitis Bundles 2015). Meta-analysis was conducted in the following four subject areas based on randomized controlled trials: (1) prophylactic antibiotics use; (2) prophylactic pancreatic stent placement for the prevention of post-ERCP pancreatitis; (3) prophylactic non-steroidal anti-inflammatory drugs (NSAIDs) for the prevention of post-ERCP pancreatitis; and (4) peritoneal lavage. Using the results of the meta-analysis, recommendations were graded to create useful information. In addition, a mobile application was developed, which made it possible to diagnose, assess severity and check pancreatitis bundles.
  
  
  CONCLUSIONS
  The JPN Guidelines 2015 were prepared using the most up-to-date methods, and including the latest recommended medical treatments, and we are confident that this will make them easy for many clinicians to use, and will provide a useful tool in the decision-making process for the treatment of patients, and optimal medical support. The free mobile application and calculator for the JPN Guidelines 2015 is available via http://www.jshbps.jp/en/guideline/jpn-guideline2015.html.
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 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: Toshihiko
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: Hepatobiliary Pancreatic & Transplant Surgery Mie University Graduate School of Medicine, Mie, Japan.
authors.forename: Shuji
authors.initials: S
authors.lastname: Isaji
authors.affiliation: Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan.
authors.forename: Keita
authors.initials: K
authors.lastname: Wada
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 Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan.
authors.forename: Naohiro
authors.initials: N
authors.lastname: Sata
authors.affiliation: Department of Radiology, Kanazawa University, School of Medical Science, Kanazawa, Japan.
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Gabata
authors.affiliation: Clinical Education Center, Kyushu University Hospital, Fukuoka, Japan.
authors.forename: Hisato
authors.initials: H
authors.lastname: Igarashi
authors.affiliation: Otsu Municipal Hospital, Shiga.|Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Keisho
authors.initials: K
authors.lastname: Kataoka
authors.affiliation: Department of Surgery, Kumamoto Regional Medical Center, Kumamoto, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Hirota
authors.affiliation: Department of Radiology, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: Masumi
authors.initials: M
authors.lastname: Kadoya
authors.affiliation: Department of Emergency and Critical Care Medicine, Kimitsu Chuo Hospital, Kisarazu, Chiba, Japan.
authors.forename: Nobuya
authors.initials: N
authors.lastname: Kitamura
authors.affiliation: Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Sapporo, Japan.
authors.forename: Yasutoshi
authors.initials: Y
authors.lastname: Kimura
authors.affiliation: Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan.
authors.forename: Seiki
authors.initials: S
authors.lastname: Kiriyama
authors.affiliation: Department of Emergency and Critical Care Medicine, Ichinomiya Municipal Hospital, Ichinomiya, Japan.
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Shirai
authors.affiliation: Department of Radiology, Tokyo Metropolitan Health and Medical Treatment Corporation, Ohkubo Hospital, Tokyo, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Hattori
authors.affiliation: Department of Surgery, National Hospital Organization Sendai Medical Center, Sendai, Japan.
authors.forename: Kazunori
authors.initials: K
authors.lastname: Takeda
authors.affiliation: Department of Surgery, Kinki University Faculty of Medicine, Osaka, Japan.
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Takeyama
authors.affiliation: Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: Morihisa
authors.initials: M
authors.lastname: Hirota
authors.affiliation: The University of Tokyo Graduate School of Public Policy, Health Policy Unit, Tokyo.
authors.forename: Miho
authors.initials: M
authors.lastname: Sekimoto
authors.affiliation: Department of Family Medicine, Mie Prefectural Ichishi Hospital, Mie, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Shikata
authors.affiliation: Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan.
authors.forename: Shinju
authors.initials: S
authors.lastname: Arata
authors.affiliation: Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Sapporo, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Hirata
mesh_terms: D003952:Diagnostic Imaging; D019468:Disease Management; D006801:Humans; D007564:Japan; D019283:Pancreatitis, Acute Necrotizing / Q000175:diagnosis* / Q000628:therapy*; D017410:Practice Guidelines as Topic
keywords: Acute pancreatitis; Antibiotics; Bundles; Diagnosis; Guidelines; Intensive care; Nutrition; Pancreas; Post-ERCP pancreatitis; Severity assessment; Surgery