Background and Aim: Acute pancreatitis (AP) is a frequent illness, with incidence of 50-80 cases per year for each 100,000 inhabitants in the United States. In Brazil the incidence is of 15.9 cases per year for each 100,000 inhabitants. The treatment of AP remains controversial in some topics, due mainly to difficulties to the accomplishment of clinical studies. Some Consensuses exist in the literature that direct the management of AP. Based on these difficulties, this research was idealized to evaluate as AP is managed by the Brazilian surgeon.
Methods: A questionnaire has been sent to 2,000 members of the Brazilian College of Surgeons, with 618 (30.9%) answers obtained. The questionnaire consisted of questions related to the experience of the surgeon and in particular to the treatment of AP, such as definition of severity, role of CT scan and ERCP, options of nutritional support, characterization of operative treatment and the use of antibiotics.
Results: With regard to the number of cases treated by the interviewed surgeons, 182 (33.6%) answered to treat up to five cases per year and 147 (27.2%) treat six to ten cases per year. The most cited criteria used for the definition of severe AP was clinical evaluation for 306 (57.4%) interviewed, followed by the Ranson criteria for 294 (55.2%), CT scan for 262 (49.2%), APACHE II for 167 (31.3%) and C-reactive protein for 68 (12.8%). Regarding the use of CT, 275 (51.5%) interviewed answered that make use of CT scan for all patients with AP. The parenteral nutritional support was the method of choice indicated for 248 (46.6%) interviewed, exclusive enteral support for 142 (26.7%), and the association of enteral and parenteral support for others 142 (26.7%). The infection of fluid collection and/or pancreatic necrosis was the main reason for surgical treatment with 447 (83.6%) answers. The optimum period to operate a patient with severe AP was considered up to seven days for 116 (22.6%) interviewed, eight to 14 days for 162 (31.6%), 15 to 21 days for 119 (23.2%) and after 21 days for 116 (22.6%). With relation to antibiotics, 371 (68.6%) use antibiotics in the treatment of severe AP, against 170 (31.4%) that answered not to use them.
Conclusion: These findings demonstrate a wide variation in the treatment of AP in Brazil, despite the number of guidelines in the literature. Little experience of the surgeons and controversial issues are probably the main factors responsible for this lack of standardization. A national Consensus based on new concepts and worldwide experience is crucial to adjust these thoughts.