Editorial
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 28, 2017; 23(16): 2826-2831
Published online Apr 28, 2017. doi: 10.3748/wjg.v23.i16.2826
Transition of early-phase treatment for acute pancreatitis: An analysis of nationwide epidemiological survey
Shin Hamada, Atsushi Masamune, Tooru Shimosegawa
Shin Hamada, Atsushi Masamune, Tooru Shimosegawa, Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan
Author contributions: Hamada S and Masamune A contributed equally to this work; Hamada S and Masamune A designed the study; Hamada S and Masamune A conducted the analysis; Masamune A and Shimosegawa T obtained the funding and directed the survey; Hamada S and Masamune A wrote the paper; and Shimosegawa T critically revised the manuscript for intellectual content.
Supported by the Smoking Research Foundation (to Masamune A).
Conflict-of-interest statement: The authors declare no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Atsushi Masamune, MD, PhD, Associate Professor, Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan. amasamune@med.tohoku.ac.jp
Telephone: +81-22-7177172 Fax: +81-22-7177177
Received: January 23, 2017
Peer-review started: January 27, 2017
First decision: February 23, 2017
Revised: February 28, 2017
Accepted: March 21, 2017
Article in press: March 21, 2017
Published online: April 28, 2017
Processing time: 94 Days and 22.1 Hours
Abstract

Treatment of acute pancreatitis (AP) is one of the critical challenges to the field of gastroenterology because of its high mortality rate and high medical costs associated with the treatment of severe cases. Early-phase treatments for AP have been optimized in Japan, and clinical guidelines have been provided. However, changes in early-phase treatments and the relationship between treatment strategy and clinical outcome remain unclear. Retrospective analysis of nationwide epidemiological data shows that time for AP diagnosis has shortened, and the amount of initial fluid resuscitation has increased over time, indicating the compliance with guidelines. In contrast, prophylactic use of broad-spectrum antibiotics has emerged. Despite the potential benefits of early enteral nutrition, its use is still limited. The roles of continuous regional arterial infusion in the improvement of prognosis and the prevention of late complications are uncertain. Furthermore, early-phase treatments have had little impact on late-phase complications, such as walled-off necrosis, surgery requirements and late (> 4 w) AP-related death. Based on these observations, early-phase treatments for AP in Japan have approached the optimal level, but late-phase complications have become concerning issues. Early-phase treatments and the therapeutic strategy for late-phase complications both need to be optimized based on firm clinical evidence and cost-effectiveness.

Keywords: Diagnostic time; Fluid resuscitation; Enteral nutrition; Continuous regional arterial infusion; Walled-off necrosis

Core tip: We analyzed past nationwide epidemiological survey data for acute pancreatitis (AP) to assess the trend in early-phase treatments and late complications. Early-phase treatments for AP in Japan have improved in line with clinical guidelines, but several points still need attention. In addition, early-phase treatments have had little impact on late complications and clinical outcomes, suggesting that an optimized strategy for late complications is still needed.