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 cl inical practice, with an assessment of the supporting evidence for each sta tement. Method: Working groups considered the published evidence in the areas of di agnosis, assessment of severity, nonoperative treatment, and surgical treat ment of severe acute pancreatitis. Outcome statements were defined to summa rize the conclusions on each point considered. The findings were discussed and agreed on by all participants. A careful assessment was made of the str ength of the available evidence (proven, probable, possible, unproven, or i nappropriate). Findings and Conclusions: There is reliable evidence to support much curren t practice. Clear guidance can be given in most areas examined, and several areas were identified where further investigation would be helpful. Diagno sis using plasma concentrations of pancreatic enzymes is reliable. Rapid ad vances are taking place in the assessment of severity. Several new therapeu tic strategies show real promise for the reduction of morbidity anal mortal ity rates. Surgical debridement is required for infected pancreatic necrosi s, but is less often necessary for sterile necrosis.