Foreword

The first Japanese edition of the Guidelines for the Management of Acute Pancreatitis was published in July 2003 [1]. Its publication was made possible by the painstaking activities that had been conducted since 1994 as a basic task of the Japanese Society for Abdominal Emergency Medicine. It has become a model for a systematic evidence search, specific recommendations at each level and preparation of flowcharts. Four years after the publication of the first edition, in 2007 a second edition in Japanese was published [2]. Despite improvement in the mortality rate of acute pancreatitis (a reduction from 7.2 to 2.9%) achieved during those 4 years, the mortality rate of the most severe cases remained above 50%. Under these circumstances, acute pancreatitis was designated an intractable disease. A revision of the guidelines presented in the second edition had become necessary owing to the accumulation of new evidence and as a result of the changes that the new evidence brought about in clinical medical care in Japan. Considering that only 2 years have passed since the publication of the second edition, doubts may arise concerning the publication of a revised edition so soon. This publication is justified, however, because the criteria for the assessment of the severity of acute pancreatitis have been examined and results published in the report of general and shared studies of intractable pancreatic diseases for the year 2008. (These studies were conducted by the Shimosegawa Group, a research group for intractable diseases and refractory pancreatic diseases, sponsored by the Ministry of Health, Labour and Welfare of Japan.) A drastic revision was thus necessary to include the new criteria for severity assessment. For example, about half of the cases that were assessed as ‘‘severe’’ on the basis of the previous criteria were assessed as ‘‘mild’’ according to the new criteria. The updated, third edition was published to maintain agreement between the criteria presented in the second edition of the Guidelines and the new criteria proposed in the studies mentioned above [3]. Although the present third edition has shown that severity assessment can be made on the basis of prognostic factors only, it has also shown that cases assessed as ‘‘severe’’ according to prognostic factors have an extremely high mortality rate when they also have been assessed as ‘‘severe’’ according to contrast-enhanced CT grade. Revisions made in accordance with the new criteria can be seen in various parts of the Guidelines. Furthermore, clinical indicators (‘‘pancreatitis bundle’’) are presented for the first time, in accordance with the present policy that assessment of compliance with the Guidelines should be conducted along with improvement in the quality of the management of acute pancreatitis. We hope that the Guidelines will make the appropriate information available to clinicians throughout the world as well as to those in Japan, and that, above all, the Guidelines will help to provide patients with the best medical care possible. The following articles are based on the studies first reported in the JPN Guidelines for the Management of Acute Pancreatitis 2010, in Japanese.