Guiding the reluctant. A primer on guidelines in general and pancreatitis in particular

Within the past 5 years, no fewer than 6 guidelines for the management of acute pancreatitis have appeared in the literature, including the current submission from the International Association of Pancreatology. When these collected guidelines are subjected to comparison, however, marked similarities emerge between the proposals, and significant differences are rare. Surprisingly, neither the passage of time nor the application of evidence-based medicine techniques to the creation of guidelines for acute pancreatitis has resulted in substantive changes to the original guidelines offered by the Atlanta Symposium. Moreover, it is important to realize that, despite claims of objectivity, opinion may enter into the process of guideline creation whenever proposals are based upon lesser levels of evidence. Until the guidelines common to these collected proposals have been supported by randomized controlled trials, it is unlikely that we need any more guidelines for acute pancreatitis.