EP-289 Acute gallstone pancreatitis – if a picture is worth a thousand words, how many images do we need?

Abstract

Abstract Aims Accurate diagnosis and prompt definitive management of choledocholithiasis is vital in acute gallstone pancreatitis (GSP). Sensitivity of detection of choledocholithiasis varies across imaging modalities. Magnetic resonance cholangiopancreatography (MRCP) is most sensitive, but may not be necessary, and may result in delayed implementation of definitive management. We aimed to evaluate the range of radiological investigations patients with acute GSP underwent at our Trust, and the clinical appropriateness of MRCP if performed. Methods An observational study of patients diagnosed with acute GSP between 01/05/2019 and 26/02/2021 was performed. Data were collected from electronic patient records. Results 50 patients were diagnosed with acute GSP (median age 56years). 41 had transabdominal ultrasound (USS), 22 had computed tomography (CT) and 16 patients had MRCP. Median waiting time was 1, 0 and 4 days for respectively. All patients who had MRCP had prior USS and/or CT (Table 1). As definitive management, 14% underwent endoscopic retrograde cholangiopancreatography (ERCP), 28% underwent laparoscopic cholecystectomy and 30% had initial ERCP followed by laparoscopic cholecystectomy. 14% patients were readmitted with pancreatitis prior to definitive management. Conclusions Detailed description of the CBD in initial radiology reports in acute GSP may mitigate the need for unnecessary subsequent imaging, reducing cost and facilitating early definitive management. We recommend establishment of a guideline to streamline imaging in the assessment of acute gallstone pancreatitis.