[Diagnosis and treatment of acute pancreatitis: are the guidelines accepted?]
P G Lankisch1, B Weber-Dany, M M Lerch
1Medizinisches Zentrum, Städtisches Klinikum Lüneburg. paulgeorg.lankisch@klinikum-lueneburg.de
Background And Objective:
Eight international guidelines exist for the diagnosis and treatment of acute pancreatitis, a disease that is often difficult to assess and treat, particularly when the necrotising variety of the disease is present. The knowledge of and compliance with these guidelines in Germany is unknown.
Method:
In order to assess the knowledge and compliance with acute pancreatitis guidelines, a structured questionnaire was sent out to the 190 members of the ALGK (Arbeitsgemeinschaft Leitender Gastroenterologischer Krankenhausärzte), a professional organisation of gastroenterology chairmen, who, in their respective institutions, are responsible for the diagnosis and treatment of acute pancreatitis. University hospitals were excluded to cover the entire severity spectrum of the disease and to avoid a referral bias.
Results:
The questionnaire was responded by 182 (96 %) members. To a large extent (acceptance > 2/3 of the consultants), guideline recommendations were complied with. There was, nevertheless, disagreement regarding the prophylactic use of antibiotics (acceptance < 2/3 of the consultants), as to when a contrast-enhanced computed tomography was indicated, and the timing of cholecystectomy for biliary pancreatitis. The choice of pain therapy for patients with acute pancreatitis also remained equivocal.
Conclusion:
Based on the high response rate which excludes a non-responder bias, the results of our study reflect the current status of the diagnosis and therapy of acute pancreatitis in Germany and to what extent international guidelines are known and complied with. This study also highlights the need for additional clinical trials in areas of diagnostic or therapeutic uncertainty.
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