Guidelines for nutrition support in
pancreatitis have been inconsistently adapted to clinical practice. The International Consensus Guideline Committee (ICGC) established a
pancreatitis task force to review published guidelines for
pancreatitis in nutrition support. A PubMed search using the terms
pancreatitis, acute pancreatitis, chronic pancreatitis, nutrition support,
parenteral nutrition,
enteral nutrition, and guidelines was conducted for the period from January 1999 to May 2011. Eleven guidelines were identified for review. The ICGC used the following process to develop unified guideline statements: summarize the strength of evidence (grading) of the guidelines; establish level of evidence for ICGC statements as high, intermediate, and low; assign published guideline levels of evidence; and define an ICGC grading system. International
Pancreatitis Guideline Grades were established as follows:
platinum-high level of evidence and consistent agreement among the guidelines;
gold-acceptable level of evidence and no conflicting statements in guidelines; and
silver-single existing guideline statement with no conflict in other guidelines. Eighteen ICGC statements were derived from the 11 published
pancreatitis guidelines. Uniform agreement from widely disparate groups (United States, Europe, Japan, and China) resulted in 4
platinum-level guideline statements for nutrition in
pancreatitis: nutrition support
therapy (NST) is generally not needed for mild to moderate disease, NST is needed for severe disease,
enteral nutrition (EN) is preferred over
parenteral nutrition (PN), and use PN when EN is contraindicated or not feasible. This methodology provides a template for future ICGC nutrition guideline development.