New data suggest that moderate fluid resuscitation is safer in acute pancreatitis than the standard aggressive fluid resuscitation. The findings suggest that an approach that includes safety and goal-directed checkpoints could enable treatment to be individualized and highlight the importance of clinical evidence in challenging dogma and improving evidence-based medicine.
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References
Iannuzzi, J. P. et al. Global incidence of acute pancreatitis is increasing over time: a systematic review and meta-analysis. Gastroenterology 162, 122–134 (2022).
Bradley, E. L. 3rd. A clinically based classification system for acute pancreatitis. Summary of the International Symposium on Acute Pancreatitis, Atlanta, Ga, September 11 through 13, 1992. Arch. Surg. 128, 586–590 (1993).
Peery, A. F. et al. Burden and cost of gastrointestinal, liver, and pancreatic diseases in the United States: update 2018. Gastroenterology 156, 254–272 (2019).
de-Madaria, E. et al. Aggressive or moderate fluid resuscitation in acute pancreatitis. N. Engl. J. Med. 387, 989–1000 (2022).
Cuthbertson, C. M. & Christophi, C. Disturbances of the microcirculation in acute pancreatitis. Br. J. Surg. 93, 518–530 (2006).
Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology 13, e1–e15 (2013).
Leppäniemi, A. et al. 2019 WSES guidelines for the management of severe acute pancreatitis. World J. Emerg. Surg. 14, 27 (2019).
Bolado, F. et al. Early weight-based aggressive vs. non-aggressive goal-directed fluid resuscitation in the early phase of acute pancreatitis: an open-label multicenter randomized controlled trial (The WATERFALL Trial), design, and rationale. Front. Med. 7, 440 (2020).
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Regnér, S. Is less more? Challenging dogma for individualized fluid resuscitation. Nat Rev Gastroenterol Hepatol 20, 133–134 (2023). https://doi.org/10.1038/s41575-022-00740-5
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DOI: https://doi.org/10.1038/s41575-022-00740-5