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Vol. 87. Issue 2.
Pages 271-272 (April - June 2022)
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Vol. 87. Issue 2.
Pages 271-272 (April - June 2022)
Letter to the Editor
Open Access
Adherence to the clinical practice guidelines for the diagnosis and treatment of acute pancreatitis
La adherencia a las guías de práctica clínica para el diagnóstico y manejo de la pancreatitis aguda
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A.S. Arroyo-Sáncheza,b,
Corresponding author
abelsalvador@yahoo.com

Corresponding author at: Jr. Grau 372, Cercado, Trujillo, Peru. Tel.: +51947842030.
, R.Y. Aguirre-Mejíaa,b
a Escuela de Medicina Humana, Universidad Privada Antenor Orrego, Trujillo, La Libertad, Peru
b Hospital Víctor Lazarte Echegaray, Seguro Social de Salud, Trujillo, La Libertad, Peru
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Roesch-Dietlen et al.1 carried out an interesting description of the knowledge and use of the different Clinical Practice Guidelines for the Diagnosis and Treatment of Acute Pancreatitis (CPGDTAPs) by attending physicians and residents of the specialties involved in the management of acute pancreatitis (AP) at 4 hospitals in the city of Veracruz, Mexico.

Their findings enable us to identify the variability in the current CPGDTAPs, as well as the knowledge of them on the part of the healthcare professionals surveyed. However, the most important aspect revealed was the prevalence of use of the CPGDTAPs that the professionals stated they were familiar with, which ranged from 0 to 55%, with respect to the residents, and 0 to 68.8%, regarding the attending physicians. In addition, 15.2% of the residents and 9.8% of the attending physicians had no knowledge of the CPGDTAPs referred to in the study.

The adherence to CPGDTAPs has been previously evaluated by other researchers and published over the past 6 years in Canada2, Singapour3, and the United States4. Those authors reviewed the clinical histories of the patients with AP and verified the presence of the CPGDTAP recommendations used, confirming that the variability of the underuse and overuse of the diagnostic and therapeutic measures of the guidelines was frequent.

Machicado et al.5 recently applied an international survey on the guidelines for nutrition in AP to 178 physicians that were members of the International Association of Pancreatology and the American Pancreatic Association, and found that only 26.7% started oral nutrition on day one in patients with mild AP, 40.9% waited > 48h to start it, and 57.3% started nutrition with a liquid diet. Regarding tube feedings, two-thirds of the physicians preferred using the post-pyloric route. The authors concluded that adherence to the recommendations of the clinical practice guidelines on oral nutrition in AP was low, and there was significant variability on the use of tube feeding.

The adherence to clinical practice guidelines is an indicator of the quality of care the patients receive, resulting in reduced morbidity and mortality rates, as well as the adequate use of medical resources and healthcare expenditure. Despite that fact, there is a heterogeneous gap between the knowledge of the CPGDTAPs and their use, in all the studies published on the theme. Such results should motivate us to conduct research at our hospitals to identify those gaps and take measures to close them.

Lastly, we suggest that each hospital center adopt one of the existing CPGDTAPs and adapt them to their logistic and resource capacity, to then diffuse them and unify the criteria between the specialties involved, thus closing said gaps. The results of the implementations should be re-evaluated and adjusted to new findings.

Financial disclosure

No financial support was received in relation to this article.

Authorship

The authors approved the final version of the article and have materially participated in its research and/or preparation.

Conflict of interest

The authors declare that there is no conflict of interest.

References
[1]
F.B. Roesch-Dietlen, L. Salgado-Vergara, Y.J. Sánchez-Maza, et al.
Conocimiento de las Guías Clínicas de Diagnóstico y Tratamiento de la Pancreatitis Aguda en médicos adscritos y residentes de los hospitales de Veracruz.
Rev Gastroenterol Mex, 86 (2021), pp. 133-139
[2]
J.A. Greenberg, J. Hsu, M. Bawazeer, et al.
Compliance with Evidence-Based Guidelines in Acute Pancreatitis: an Audit of Practices in University of Toronto Hospitals.
J Gastrointest Surg, 20 (2016), pp. 392-400
[3]
J.W. Tan, Y. Gao, A.W.C. Kow, et al.
Clinical management and outcomes of acute pancreatitis: Identifying areas for quality improvement in a tertiary Asian setting.
Pancreatology, 19 (2019), pp. 507-518
[4]
K. Kline, M. Bilal, F. Marcondes, et al.
Evaluating Adherence to Guideline-Based Care in Diagnosis and Management of Acute Pancreatitis at an Academic Medical Center - A Quality Improvement Project.
Am J Gastroenterol, 113 Suppl (2018), pp. S12-S13
[5]
J.D. Machicado, S. Wani, E. Quingalahua, et al.
Practice patterns and adherence to nutrition guidelines in acute pancreatitis: an international physician survey.
Pancreatology, 21 (2021), pp. 642-648

Please cite this article as: Arroyo-Sánchez AS, Aguirre-Mejía RY. La adherencia a las guías de práctica clínica para el diagnóstico y manejo de la pancreatitis aguda. Rev Gastroenterol Méx. 2022;87:271–272.

Copyright © 2022. Asociación Mexicana de Gastroenterología
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