AEG-AESPANC-OPGE-SIED-SPG Ibero-Latin American Guidelines on Acute Pancreatitis (iLATAM-AP).

introductionAcute pancreatitis (AP) is a major cause of gastrointestinal hospitalizations worldwide. Although typically self-limiting, up to one-third of cases develop complications associated with increased morbidity and mortality. Despite recent advances that have improved outcomes, clinical heterogeneity necessitates updated, evidence-based guidance. In addition, there remains a need to improve the implementation of evidence-based recommendations across Ibero-Latin American countries by bringing together diverse scientific societies and regional experts to enhance applicability and the dissemination of best practices. This guideline offers comprehensive recommendations for both mild and complicated AP diagnosis and management.

methodsQuestions on AP management were addressed by expert teams comprising one coordinator and four pancreatology specialists from the Iberian Peninsula and Latin America. For each question, a systematic review was conducted using PubMed, Embase, and the Cochrane Library, focusing on randomized controlled trials and systematic reviews published between January 1979 and March 2024 in English, Spanish, or Portuguese. In the absence of high-quality evidence, the search was expanded to include observational studies. Recommendations were formulated using the GRADE system and submitted to an expert panel for consensus; unresolved questions were revised and resubmitted until consensus was reached.

resultsTwenty evidence-based recommendations were developed, addressing key aspects of AP management, including definitions, diagnostic criteria, etiological assessment, initial management, management of local complications, splanchnic vein thrombosis, abdominal compartment syndrome, indications for intensive care admission, antibiotic use, early endoscopic retrograde cholangiopancreatography, timing of cholecystectomy, strategies for detecting choledocholithiasis, and the management of pancreatic function insufficiency. Each recommendation included a statement, the level of evidence, the strength of the recommendation, and a summary of the supporting evidence.

conclusionThe iLATAM guidelines are the first Ibero-Latin American clinical practice guidelines for AP. They provide evidence-based recommendations integrating medical, endoscopic, and surgical approaches, with the aim of promoting consistent, high-quality care across diverse healthcare settings. TRAIL REGISTRATION: In alignment with international standards for transparency and methodological rigor, the methodological protocol for this guideline was registered in PROSPERO (International Prospective Register of Systematic Reviews) on July 23, 2022 (Registration ID: CRD42022345788).