Acute pancreatitis bundles: 10 clinical regulations for the early management of patients with severe acute pancreatitis in Japan

Acute pancreatitis (AP) is an inflammatory disease of diverse severity. Early management is indispensable to cure patients with AP, especially those who show symptoms of severe AP (SAP) [1-3]. The mortality from sepsis, which is another fatal disease, has been improved by the establishment and implementation of guidelines for the early management with sepsis change bundles for the initial resuscitation (6 h) and management (24 h) [4]. Pancreatitis bundles, which consist of 10 statements extracted from the Japanese guidelines for AP, specify the management and treatment within the first 48 h after the onset of SAP. They were established in 2010 for the purpose of improving the mortality of SAP patients (Table 1) [5]. We conducted a nationwide survey of patients who developed AP in 2011 in Japan. The survey consisted of two sequential surveys [6]. The first survey was carried out by mailing a questionnaire to 4,175 randomly chosen departments in Japan. The response rate of the first survey was 45.8%. Finally, clinical data of 2,694 patients with AP were collected by the second survey. The rate of implementation of each statement in the pancreatitis bundles was investigated by the second survey. Additionally, we studied the effect of following or not following the pancreatitis bundles on the mortality of patients with SAP. SAP was defined by the Japanese severity scoring system in this study [6].