Home Treatment of Acute Pancreatitis

Between 11/11-5/12, 84 patients with mild NAAP were randomized to home or hospital groups after a short (≤24 hours) hospital stay. AP was defined as ≥2 or more of the following: characteristic abdominal pain, amylase and/or lipase ≥3X the upper limit of normal, and/or imaging findings. Patients with an Imrie's score ≤5 and a harmless acute pancreatitis score (HAPS) ≤2 were included. Patients in both groups received intravenous lactated Ringer for 3 days and pain was treated with intramuscular diclofenac. A nurse visited all patients in the home group on the 2nd, 3rd and 5th day. All patients recalled for follow-up on the 7th, 14th, and 30th days.

Inclusion criteria

• Diagnosis of AP based on 2 out of 3 findings: characteristic abdominal pain, amylase and/or lipase levels ≥3 times the upper limit of normal, and/or abdominal imaging demonstrating changes of acute pancreatitis
• Presentation within 48 hours of symptom onset
• Imrie's scores of ≤5 and HAP score ≤2 within 24 hours of presentation to the hospital
• Lack of hemoconcentration (hematocrit ≥44%) on presentation since hemoconcentration has been shown to be a risk factor for pancreatic necrosis.

Exclusion criteria

• The presence of organ failure by the Atlanta criteria on the first day of presentation
• The presence of clinical signs and/or symptoms of sepsis
• Alcoholic acute pancreatitis
• A history of abdominal imaging demonstrating a dilated pancreatic duct and/or pancreatic calcifications
• Coagulopathy (international normalized ratio >1, and/or platelet count <50,000/mm3
• Comorbidities requiring hospitalization regardless of the presence of AP e.g. acute myocardial infarction, malignancy, cirrhosis, chronic kidney disease, and chronic pulmonary disease)