Controversies in the management of acute pancreatitis in the emergency department: An updated literature review

Abstract

Objective: Identify controversial management strategies for acute pancreatitis in the context of an emergency department and the literature that supports or rejects them. Methodology: A qualitative narrative systematic literature review was conducted to evaluate the efficacy and safety of various strategies in the management of acute pancreatitis in the emergency department. Articles published between 2018 and 2025 were searched in recognized databases such as PubMed, Cochrane, Database of Systematic Reviews, Google Scholar, Web of Science and Scopus, both in Spanish and English. Results: A total of 28 scientific articles were included, covering approaches such as aggressive intravenous hydration, early nutrition and feeding routes, prophylactic antibiotic use, invasive interventions such as endoscopic retrograde cholangiopancreatography, and percutaneous, abdominal, or surgical drainage. Their associations with complications, length of hospital stay, morbidity, mortality, and disease severity were examined, providing an updated framework for clinical decision-making in this setting. Conclusions: The use of goal-directed fluid therapy is recommended versus aggressive hydration. Oral nutrition should be started as soon as possible, depending on the patient's tolerance. If clinically indicated, a nasogastric tube is preferred over a naso-jejunal tube, with some exceptions. Parenteral nutrition is reserved as a last resort or as a backup if nutritional goals are not achieved. Antibiotic therapy should be used only in select cases where an infectious process is confirmed or strongly suspected, and not routinely as a prophylactic measure. Urgent ERCP is recommended only in cases with concomitant persistent cholangitis or cholelithiasis. More invasive interventions should be stepwise, exhausting noninvasive treatments and involving multidisciplinary assessments.