Anjala Tess, MD; Steven D. Freedman, MD, PhD; Tara Kent, MD; Howard Libman, MD
Acknowledgment: The authors thank the patient for sharing his story.
Grant Support: Beyond the Guidelines receives no external support.
Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-3536.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Proctor & Gamble, Pfizer, and Johnson & Johnson.
Corresponding Author: Anjala Tess, MD, Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, E/Yamins 102, 330 Brookline Avenue, Boston, MA 02215; e-mail, email@example.com.
Current Author Addresses: Drs. Tess, Freedman, Kent, and Libman: Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215.
Acute pancreatitis, a common cause of hospitalization in the United States, is often the result of biliary tract disease. In 2016, the American Gastroenterological Association released a guideline that addresses the practical considerations in managing acute pancreatitis within the first 72 hours after the patient presents. The guideline specifically recommends goal-directed hydration therapy, early enteral feeding, judicious use of endoscopic retrograde cholangiopancreatography (ERCP), and gallbladder surgery during the index admission for patients with mild pancreatitis. The authors discuss their approach to these interventions in the context of a patient with recurrent acute pancreatitis who chooses to delay surgery until after hospital discharge. They address hydration and timing of surgery, as well as how they would manage the patient's preferences in the face of existing guidelines.
Tess A, Freedman SD, Kent T, Libman H. How Would You Treat This Patient With Gallstone Pancreatitis?: Grand Rounds Discussion From Beth Israel Deaconess Medical Center. Ann Intern Med. ;170:175–181. doi: 10.7326/M18-3536
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Published: Ann Intern Med. 2019;170(3):175-181.
Biliary Disorders, Gastroenterology/Hepatology, Pancreatic Disease.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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