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2017 ; 5
(2
): 153-199
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United European Gastroenterology evidence-based guidelines for the diagnosis and
therapy of chronic pancreatitis (HaPanEU)
#MMPMID28344786
Löhr JM
; Dominguez-Munoz E
; Rosendahl J
; Besselink M
; Mayerle J
; Lerch MM
; Haas S
; Akisik F
; Kartalis N
; Iglesias-Garcia J
; Keller J
; Boermeester M
; Werner J
; Dumonceau JM
; Fockens P
; Drewes A
; Ceyhan G
; Lindkvist B
; Drenth J
; Ewald N
; Hardt P
; de Madaria E
; Witt H
; Schneider A
; Manfredi R
; Brøndum FJ
; Rudolf S
; Bollen T
; Bruno M
United European Gastroenterol J
2017[Mar]; 5
(2
): 153-199
PMID28344786
show ga
BACKGROUND: There have been substantial improvements in the management of chronic
pancreatitis, leading to the publication of several national guidelines during
recent years. In collaboration with United European Gastroenterology, the working
group on 'Harmonizing diagnosis and treatment of chronic pancreatitis across
Europe' (HaPanEU) developed these European guidelines using an evidence-based
approach. METHODS: Twelve multidisciplinary review groups performed systematic
literature reviews to answer 101 predefined clinical questions. Recommendations
were graded using the Grading of Recommendations Assessment, Development and
Evaluation system and the answers were assessed by the entire group in a Delphi
process online. The review groups presented their recommendations during the 2015
annual meeting of United European Gastroenterology. At this one-day, interactive
conference, relevant remarks were voiced and overall agreement on each
recommendation was quantified using plenary voting (Test and Evaluation
Directorate). After a final round of adjustments based on these comments, a draft
version was sent out to external reviewers. RESULTS: The 101 recommendations
covered 12 topics related to the clinical management of chronic pancreatitis:
aetiology (working party (WP)1), diagnosis of chronic pancreatitis with imaging
(WP2 and WP3), diagnosis of pancreatic exocrine insufficiency (WP4), surgery in
chronic pancreatitis (WP5), medical therapy (WP6), endoscopic therapy (WP7),
treatment of pancreatic pseudocysts (WP8), pancreatic pain (WP9), nutrition and
malnutrition (WP10), diabetes mellitus (WP11) and the natural course of the
disease and quality of life (WP12). Using the Grading of Recommendations
Assessment, Development and Evaluation system, 70 of the 101 (70%)
recommendations were rated as 'strong' and plenary voting revealed 'strong
agreement' for 99 (98%) recommendations. CONCLUSIONS: The 2016 HaPanEU/United
European Gastroenterology guidelines provide evidence-based recommendations
concerning key aspects of the medical and surgical management of chronic
pancreatitis based on current available evidence. These recommendations should
serve as a reference standard for existing management of the disease and as a
guide for future clinical research.