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DOI: 10.1055/s-2005-871875
© Georg Thieme Verlag Stuttgart · New York
Diagnose und Therapie der akuten Pankreatitis: Werden die Leitlinien akzeptiert?[1]
Diagnosis and treatment of acute pancreatitis: Are the guidelines accepted?Publication History
eingereicht: 9.5.2005
akzeptiert: 16.6.2005
Publication Date:
30 June 2005 (online)

Zusammenfassung
Hintergrund und Fragestellung: Zur Diagnostik und Therapie der akuten Pankreatitis, einem - besonders bei Vorliegen der nekrotisierenden Verlaufsform - oft schwierig zu beurteilenden und zu behandelnden Krankheitsbild, wurden international 8 Leitlinien erstellt. Der Verbreitungsgrad und ihre Akzeptanz in Deutschland sind unbekannt.
Methode: Zur Überprüfung des Bekanntheitsgrades und der Akzeptanz der Leitlinien wurde per Postversand eine Befragung der 190 Mitglieder der Arbeitsgemeinschaft Leitender Gastroenterologischer Krankenhausärzte (ALGK) durchgeführt, die in ihren Institutionen die Diagnostik und Therapie der akuten Pankreatitis festlegen. Universitäre Zentren wurden ausgeschlossen, um das gesamte Schweregradspektrum der Erkrankung abzubilden und einen „referral bias” zu vermeiden.
Ergebnisse: Von den Befragten antworteten 182 (96 %). Die meisten Leitlinien wurden in hohem Umfang (Akzeptanz von > 2/3 der Befragten) befolgt. Unsicherheit (Akzeptanz < 2/3 der Befragten) bestand bei der Indikation zur Kontrastmittel-verstärkten Computertomographie, bei der prophylaktischen Gabe von Antibiotika und beim Zeitpunkt der Cholezystektomie bei biliärer Pankreatitis. Darüber hinaus ist die Auswahl der Schmerztherapie bei akuter Pankreatitis noch umstritten.
Folgerung: Aufgrund der hohen Rückantwortquote und des somit ausgeschlossenen „non-responder bias” spiegelt diese Befragung den derzeitigen Stand der Diagnostik und Therapie der akuten Pankreatitis, aber auch der Akzeptanz der Leitlinienempfehlung in Deutschland wider. Diese Untersuchung zeigt auch, auf welchen Gebieten noch Bedarf für klärende klinische Studien besteht.
Summary
Background and objective: Eight international guidelines exist for the diagnosis and treatment of acute pancreatitis, a disease that is often difficult to assess and treat, particularly when the necrotising variety of the disease is present. The knowledge of and compliance with these guidelines in Germany is unknown.
Method: In order to assess the knowledge and compliance with acute pancreatitis guidelines, a structured questionnaire was sent out to the 190 members of the ALGK (Arbeitsgemeinschaft Leitender Gastroenterologischer Krankenhausärzte), a professional organisation of gastroenterology chairmen, who, in their respective institutions, are responsible for the diagnosis and treatment of acute pancreatitis. University hospitals were excluded to cover the entire severity spectrum of the disease and to avoid a referral bias.
Results: The questionnaire was responded by 182 (96 %) members. To a large extent (acceptance > 2/3 of the consultants), guideline recommendations were complied with. There was, nevertheless, disagreement regarding the prophylactic use of antibiotics (acceptance < 2/3 of the consultants), as to when a contrast-enhanced computed tomography was indicated, and the timing of cholecystectomy for biliary pancreatitis. The choice of pain therapy for patients with acute pancreatitis also remained equivocal.
Conclusion: Based on the high response rate which excludes a non-responder bias, the results of our study reflect the current status of the diagnosis and therapy of acute pancreatitis in Germany and to what extent international guidelines are known and complied with. This study also highlights the need for additional clinical trials in areas of diagnostic or therapeutic uncertainty.
1 Teile der Ergebnisse dieser Arbeit werden in einem „Letter to the Editor” in Pancreatology 2005 veröffentlicht.
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1 Teile der Ergebnisse dieser Arbeit werden in einem „Letter to the Editor” in Pancreatology 2005 veröffentlicht.
Prof. Dr. P. G. Lankisch
Klinik für Allgemeine Innere Medizin, Medizinisches Zentrum, Städtisches Klinikum
Lüneburg
Bögelstraße 1
21339 Lüneburg
Phone: +49/4131/772240
Fax: +49/4131772245
Email: paulgeorg.lankisch@klinikum-lueneburg.de