Evidence map›Paper›PMID 16432347›Full record

SynthesisAnnals of surgery2006

Evidence-based treatment of acute pancreatitis: a look at established paradigms.

Stefan Heinrich, Markus Schäfer, Valentin Rousson, Pierre-Alain Clavien

Open access · greenAbstract readMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Annals of surgery, 2006. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 100 papers, 13 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
100citing papers in PubMed, 13 pooled it
42.2field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

100 citing papers in PubMed, 13 syntheses or guidelines pooled it, 330 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Efficacy of glucocorticoids in rodents of severe acute pancreatitis: a meta-analysis.International journal of clinical and experimental pathology · 2014
    Pooled it
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  5. Guideline
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  14. Trial
  15. A prospective, randomized trial of clear liquids versus low-fat solid diet as the initial meal in mild acute pancreatitis.Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association · 2007
    Trial
  16. Safety and efficacy of vitamin-based antioxidant therapy in patients with severe acute pancreatitis: a randomized controlled trial.Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association
    Trial
  17. Review
  18. Article
  19. The Effects of Rhein and Honokiol on Metabolic Profiles in a Mouse Model of Acute Pancreatitis.Medical science monitor : international medical journal of experimental and clinical research · 2020
    Article
  20. Article

40 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

4 authors at 2 institutions in 1 country.

Stefan HeinrichSwiss HPB Center, Department of Visceral and Transplantation Surgery, University Hospital of Zurich, Zurich, Switzerland.
Markus Schäfer
Valentin Rousson
Pierre-Alain Clavien
University Hospital of Zurich · CHInstitute of Social and Preventive Medicine · CH

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe management of acute pancreatitis (AP) is still based on speculative and unproven paradigms in many centers. Therefore, we performed an evidence-based analysis to assess the best available treatment.

methodsA comprehensive Medline and Cochrane Library search was performed evaluating the indication and timing of interventional and surgical approaches, and the value of aprotinin, lexipafant, gabexate mesylate, and octreotide treatment. Each study was ranked according to the evidence-based methodology of Sackett; whenever feasible, we performed new meta-analyses using the random-effects model. Recommendations were based on the available level of evidence (A=large randomized; B=small randomized; C=prospective trial).

resultsNone of the evaluated medical treatments is recommended (level A). Patients with AP should receive early enteral nutrition (level B). While mild biliary AP is best treated by primary cholecystectomy (level B), patients with severe biliary AP require emergency endoscopic papillotomy followed by interval cholecystectomy (level A). Patients with necrotizing AP should receive imipenem or meropenem prophylaxis to decrease the risk of infected necrosis and mortality (level A). Sterile necrosis per se is not an indication for surgery (level C), and not all patients with infected necrosis require immediate surgery (level B). In general, early necrosectomy should be avoided (level B), and single necrosectomy with postoperative lavage should be preferred over "open-packing" because of fewer complications with comparable mortality rates (level C).

conclusionsWhile providing new insights into key aspects of AP management, this evidence-based analysis highlights the need for further clinical trials, particularly regarding the indications for antibiotic prophylaxis and surgery.

Indexed as

Acute DiseaseAnti-Bacterial AgentsAntibiotic ProphylaxisAprotininCholecystectomyEnteral NutritionEvidence-Based MedicineGabexateGastrointestinal AgentsHumansImidazolesImipenemLeucineMeropenemOctreotidePancreatitisAnti-Bacterial AgentsAprotininGabexateGastrointestinal AgentsImidazolesImipenemLeucinelexipafantMeropenemOctreotidePlatelet Activating FactorSerine Proteinase InhibitorsThienamycins

Identifiers

PMID16432347
PMCPMC1448904
OpenAlexW2044545694

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.