Pancreatitis Research Articles

Cecal Volvulus Presenting after Onset of Acute Pancreatitis: A Case Report

Cecal volvulus is a rare, potentially life-threatening cause of large bowel obstruction (LBO). Discerning LBO in the background of chronic episodes of epigastric or abdominal pain ensures timely treatment and reduces the risk of complications. Atypical demographic presentation may pose a clinical danger that can be best avoided with standardized diagnostic imaging. We report a case of cecal volvulus in a male patient with a history of alcohol use disorder and pancreatitis. The patient underwent a right hemicolectomy with small bowel resection and primary anastomosis.

NLR48 is Better Than CRP, and mCTSI, and Similar to BISAP and SOFA Scores for Mortality Prediction in Acute Pancreatitis: A Comparison of 6 Scores.

The neutrophil-lymphocyte ratio (NLR) has been suggested as a reliable marker for predicting inflammation progression and severity of acute pancreatitis, although the role of the NLR stratified by etiology is still insufficiently studied. However, the NLR's role in mortality prediction was poorly evaluated in the literature. We performed a retrospective, cross-sectional study to analyze the role of NLR0 (at admission) and NLR48 (at 48 hours) in acute pancreatitis as compared with CRP, BISAP, SOFA, and modified CTSI (mCTSI) for the prediction of mortality and severe acute pancreatitis (SAP) in patients admitted into the Emergency Clinical County Hospital of Craiova during 48 months. The primary assessed outcomes were the rate of in-hospital mortality, the rate of persistent organ failure, and ICU admissions. We analyzed mortality prediction for all acute pancreatitis, for biliary, alcoholic, and hypertriglyceridemic acute pancreatitis, for severe forms, and for patients admitted to the ICU. A total of 725 patients were selected; 42.4% had biliary acute pancreatitis, 27.7% had alcoholic acute pancreatitis, and 8.7% had hypertriglyceridemia-induced acute pancreatitis. A total of 13.6% had POF during admission. The AUC for NLR48 in predicting mortality risk and SAP was 0.81 and 0.785, superior to NLR0, CRP48, and mCTSI but inferior to BISAP and SOFA scores. The NLR48/NLR0 ratio did not add significantly to the accuracy. NLR0 and NLR48 performed poorly for mortality prediction in severe forms and in patients admitted to the ICU. NLR48 has good accuracy in our study for predicting death risk in biliary and alcoholic acute pancreatitis but not in hypertriglyceridemic acute pancreatitis. NLR48 was a good indicator in predicting mortality risk and severe forms in all patients with acute pancreatitis, but not of death in SAP and in patients admitted to ICU, with good accuracy for predicting death risk in biliary and alcoholic acute pancreatitis but not in hypertriglyceridemic acute pancreatitis.

Inefficiency in Delivery of General Surgery to Black Patients: A National Inpatient Sample Study.

Background Racial disparities in outcomes among patients in the United States are widely recognized, but disparities in treatment are less commonly understood. This study is intended to identify treatment disparities in delivery of surgery and time to surgery for diagnoses managed by general surgeons-appendicitis, cholecystitis, gallstone pancreatitis, abdominal wall hernias, intestinal obstructions, and viscus perforations. Methods The National Inpatient Sample (NIS) was used to estimate and analyze disparities in delivery of surgery, type of surgery received, and timing of surgery. Age-adjusted means were compared by race/ethnicity and trends in treatment disparities were evaluated from 1993 to 2017. Linear modeling was used to measure trends in treatment and outcome disparities over time. Mediation analysis was performed to estimate contributions of all available factors to treatment differences. Relationships between treatment disparities and disparities in mortality and length of stay were similarly evaluated. Results Black patients were less likely to receive surgery for appendicitis, cholecystitis, pancreatitis, and hernias, and more likely to receive surgery for obstructions and perforations. Black patients experienced longer wait times prior to surgery, by 0.15 to 1.9 days, depending on the diagnosis. Mediation analysis demonstrated that these disparities are not attributable to the patient factors available in the NIS, and provided some insight into potential contributors to the observed disparities, such as hospital factors and socioeconomic factors. Conclusion Treatment disparities are present even with common indications for surgery, such as appendicitis, cholecystitis, and gallstone pancreatitis. Black patients are less likely to receive surgery with these diagnoses and must wait longer for surgery if it is performed. Surgeons should plan institution-level interventions to measure, explain, and potentially correct treatment disparities.

S120 Comparison of Local and Systemic Complications of Acute Biliary and Alcoholic Pancreatitis in the US 2016-2020: A Propensity Matched Analysis

S120 Comparison of Local and Systemic Complications of Acute Biliary and Alcoholic Pancreatitis in the US 2016-2020: A Propensity Matched Analysis

S1217 Factors That Impact Patients Who Present With Acute Gallstone Pancreatitis Who Undergo ERCP vs ERCP + Cholecystectomy

S1217 Factors That Impact Patients Who Present With Acute Gallstone Pancreatitis Who Undergo ERCP vs ERCP + Cholecystectomy

S39 Impact of Frailty on Acute Alcoholic Pancreatitis Outcomes: A Nationwide Readmissions Database Study

S39 Impact of Frailty on Acute Alcoholic Pancreatitis Outcomes: A Nationwide Readmissions Database Study

Method of Choice for Pancreatic Enteroanastomosis Formation in Patients with Chronic Pancreatitis and Malignant Neoplasms of Pancreas

Introduction. Pancreatic enteroanastomosis formation is a decisive stage of the entire operation, as the frequency of complications leading to death remains high.The aim of the study was to improve the clinical outcomes of surgical interventions on pancreas by choosing the proper technique for pancreatic enteroanastomosis formation.Materials and methods. A retrospective-prospective study was performed in the Center for Surgery of the Liver, Pancreas and Biliary Tracts, Ryazan State Medical University. The retrospective stage included the analysis of 270 operation protocols and case histories of patients undergone pancreatic resection. Based on the analysis, the academic staff of the Department of Hospital Surgery, Ryazan State Medical University, developed a technique for pancreatic jejunoanastomosis via through U-shaped sutures (the modified Blumgart-style pancreaticojejunostomy).The prospective stage included analysis of 98 case histories and operation protocols of patients undergone pancreatic resection. There were 73 patients with chronic pancreatitis and 25 patients with the head of the pancreas cancer. Groups were formed uniformly depending on the etiology.Statistical analysis methods included: multivariate correlation analysis using the contingency coefficient (); Shapiro-Wilk test; Pearson's chi-squared test; one-way ANOVA test and multiple comparison method with Bonferroni correction for Student's t-test.Results. Correlation between the infiltrated pancreas and the frequency of complications - was 0.517.The frequency of anastomosis failure with the PD diameter 3 - was 0.167, with PG3mm - = 0.358.The infiltrated parenchyma of the pancreas and the PD diameter 3 mm affected the incidence of postoperative complications - = 0.387 (PG 3 mm, the incidence of postoperative complications - = 0.254).At the reconstructive stage, patients of group 1 were exposed to pouch-invagination pancreatic enteroanastomosis end-to-side, patients of group 2 were exposed to pancreatic enteroanastomosis using nodular sutures, patients of group 3 were exposed to pancreatic jejunoanastomosis using through U-shaped sutures, the modified Blumgart-style pancreaticojejunostomy. In patients from group 1 complications were observed in 58% of cases, in patients from group 2 complications were observed in 45.4% of cases, in patients from group 3 complications were observed in 20.5% of cases (p=0.010). Pancreatic enteroanastomosis failed in 29% of patients from group 1, and in 21.2% of patients from group 2; in patients from group 3 no pancreatic enteroanastamosis failure was observed (p = 0.003). There were 9.7% of gastrostasis cases in patients from group 1, 9.1% of gastrostasis cases in patients from group 2, 8.8% of gastrostasis cases in patients from group 3 (p = 0.1). Postoperative pancreatitis was observed in 12.9% of patients from group 1, in 9.1% of patients from group 2, in 5.9% of patients from group 3 (p=0.015). Twenty-nine percent of patients from group 1, 18.1% of patients from group 2, 2.9% of patients from group 3 required repeated surgical interventions.Conclusions. In case of through U-shaped sutures application, repeated surgical interventions for pancreatic jejunoanastomosis were performed in 2.9% of cases, the rate of postoperative complications was 20.5%, no anastomosis failure was observed.Pancreatic jejunoanastomosis using through U-shaped sutures has proven to be more effective compared to other pancreatic enteroanastomosis techniques applied in clinical practice. It can be used in educational and pedagogical and research activities in medical universities.

Time to interval cholecystectomy and associated outcomes in a population aged 50 and above with mild gallstone pancreatitis

BackgroundCholecystectomy on index admission for mild gallstone pancreatitis (GSP) is recommended, although not always feasible. This study examined rates and outcomes of people aged ≥ 50 years who underwent interval (delayed) cholecystectomy at increasing time points.MethodsHospitalisation and death data were linked for individuals aged ≥ 50 years admitted to hospital in New South Wales, Australia with mild GSP between 2008–2018. Primary outcome was interval cholecystectomy timing. Secondary outcomes included mortality, emergency readmission for gallstone-related disease (GSRD) (28 and 180-day), and length of stay (LOS) (index admission and total six-month GSRD).Results3,003 patients underwent interval cholecystectomy: 861 (28.6%) at 1–30, 1,221 (40.7%) at 31–90 and 921 (30.7%) at 91–365 days from index admission. There was no difference in 365-day mortality between groups. Longer delay to cholecystectomy was associated with increased 180-day emergency GSRD readmission (17.5% vs 15.8% vs 19.9%, p < 0.001) and total six-month LOS (5.9 vs 8.4 vs 8.3, p < 0.001). Endoscopic retrograde cholangiopancreatography (ERCP) was increasingly required with cholecystectomy delay (14.5% vs 16.9% vs 20.4%, p < 0.001), as were open cholecystectomy procedures (4.8% vs 7.6% vs 11.3%, p < 0.001). Extended delay was associated with patients of lower socioeconomic status, regional/rural backgrounds or who presented to a low volume or non-tertiary hospital (p < 0.001).ConclusionDelay to interval cholecystectomy results in increased rates of emergency readmission, overall LOS, risks of conversion to open surgery and need for ERCP. Index admission cholecystectomy is still recommended, however when not possible, interval cholecystectomy should be performed within 30 days to minimise patient risk and healthcare burden.

National Trends in Interventions for Pediatric Gallstone Pancreatitis.

Introduction: Laparoscopic cholecystectomy (LC) during index hospitalization for gallstone pancreatitis is standard in adult populations. The objective of this study was to evaluate trends in use of LC and endoscopic retrograde cholangiopancreatography (ERCP) for children with gallstone pancreatitis. Materials and Methods: This retrospective cohort study used the Kids' Inpatient Database, spanning 2000-2019, to identify patients aged 18 years or younger with a principal diagnosis of gallstone pancreatitis. The Mann-Kendall trend test was used to assess trends over time. Results: Gallstone pancreatitis occurred in 5028 patients. The rate of LC during index hospitalization ranged from 55.4% to 63.8% (P = .76). Trends demonstrate that LC occurred on average hospital day 4.6 in 2000 and decreased to 3.4 in 2019 (P < .01). Among those undergoing LC, average length of stay (LOS) decreased from 6.8 days in 2000 to 5.1 days in 2019 (P < .01). The rate of ERCP alone decreased from 24.8% in 2000 to 14.0% in 2019 (P = .23). For those undergoing ERCP, average hospital day of ERCP decreased from 3.3 in 2000 to 2.3 in 2019 (P = .07). The rate of undergoing both an ERCP and LC decreased from 19.0% in 2000 to 8.5% in 2019 (P = .13). For patients who underwent either LC or ERCP, average LOS decreased from 7.0 days in 2000 to 5.1 days in 2019 (P < .01). For patients who did not undergo a procedure, average LOS decreased from 5.7 days in 2000 to 4.0 days in 2019 (P = .13). Conclusion: The proportion of LC performed during index hospitalizations for children with gallstone pancreatitis has been stable for two decades. However, trends indicate that interventions are occurring earlier, and LOS is becoming shorter.

1268 An Audit of the Time to Surgery Following Diagnosis of Gallstone Pancreatitis

Abstract Aim To assess the compliance of our trust with the British Gastroenterology guidelines (BSG) on the management of gallstone pancreatitis which recommends that patients should undergo definitive treatment of laparoscopic cholecystectomy during the index admission or within 2 weeks of discharge to prevent readmission with biliary complications. Method This was a retrospective study of patients admitted with gallstone pancreatitis over a 3-month period between January 2021 and March 2021. We collected data from electronic medical records (EPR) and collated them on Microsoft Excel. Data was gathered on patient demographics, diagnosis at presentation, number of days to surgery, rate of readmission and the reasons for this. Results A total of 21 patients were admitted with gallstone pancreatitis. The median age was 50 years and 52% of them were male. 14 (67%) patients had laparoscopic cholecystectomy and only 9 (64%) of these had it within the 2-week window. 7 (33%) patients did not have surgery. Of these, 4 of them were not eligible, 1 went private and 2 patients are still awaiting surgery. The median wait for surgery was 3 days. The average time to surgery was 64 days. There were 6 readmissions whilst waiting for surgery with pain being the most common reason. Conclusions 64% of patients had definitive treatment of laparoscopic cholecystectomy within the 2-week time frame demonstrating poor compliance with the BSG guidelines. We have introduced a semi-emergency theatre list once a week to accommodate definitive management of patients with gallstone pancreatitis and will re-audit the data to evaluate for improvement.

1158 Outcome of Hot Laparoscopic Cholecystectomy Service Evaluation in Morriston Hospital, SBUHB

Abstract Aim Symptomatic Gall Bladder disease is a common general surgery presentation. NICE guidelines recommend performing laparoscopic cholecystectomy (within 1 week of diagnosis) for patients with acute cholecystitis. Patients who had gall stone pancreatitis should have laparoscopic cholecystectomy on the index admission. Historically poor availability of theatre slots has resulted in unacceptable delays in our health board. The objective of this study was to evaluate adherence to these recommendations before and after an intervention to improve theatre access. Method A retrospective study of inpatient laparoscopic cholecystectomies between 20/06/2022 and 28/11/2022 was undertaken in Morriston Hospital. On 20/09/2022, dedicated theatre lists for laparoscopic cholecystectomy were moved from afternoon sessions to morning or all-day sessions with the intention of minimising delays. Baseline patient and operative details were captured from electronic health records. Outcomes were adherence to recommendations from NICE and time to procedure from booking and number of procedures done before and after the intervention. Result 85 patients were included (42 patients before (Group 1) and 43 after the intervention (Group 2). 100% of patient from group 1 received cholecystectomy within a week of booking compared to 86% from group 2 (P = 0.09). Mean time to procedure was 2.5 days and 3.5 days for group 1 and group 2 respectively (P = 0.076). 3.5 patients received cholecystectomy per week in group 1 as compared to 4.4 in group 2. Conclusions Changing the timing of Theatre lists from Afternoon to Morning/all day resulted in more patients receiving cholecystectomies without compromising time from booking to procedure

1162 Management of Acute Gallstone Disease at an Urban Acute Trust During the Pandemic – Closed-Loop Audit

Abstract Aim Acute gallstone disease is a surgical emergency with emphasis on early surgery (Laparoscopic Cholecystectomy (LC)) to improve outcomes. Method Patients presenting with acute cholecystitis, biliary colic, and gallstone pancreatitis between September and December 2021 were retrospectively audited. We measured re-admission rates, emergency and elective cholecystectomies performed, and interval between operation and initial admission. This revealed a need for improvement in the service provided at this trust. An intervention was implemented with the Hot Cholecystectomy list being available for other surgeons as well as encouraging acute LC on the Emergency theatre list. A follow-up retrospective audit was carried out between July and September 2022 using the same criteria as per the initial data collection. Results 240 patients were admitted with acute gallstone disease during the initial audit period. At the end of audit period, 49 patients underwent LC, of which only 20% were performed acutely. However, 70% of acute operations were performed during re-admissions. During the re-audit, 109 patients were admitted with acute gallstone disease. Within the three months, 21% of patients underwent LC, out of which 52% were acute operations. 50% of the emergency operations were in re-admission patients. Patients from the initial audit were followed up which revealed average waiting time of 118.5 days from admission to LC Conclusions There was almost a 3-fold increase in the rate of Emergency LC post intervention. While there is an increase, provision of emergency cholecystectomies does not comply with national guidelines. Resources need to be allocated nationwide for timely treatment of acute gallstone disease.

FTP7.9 Not all necrotising pancreatitis are the same: does aetiology affect the extent pancreatic necrosis? A single-centre retrospective study

Abstract Aim To assess the extent of pancreatic necrosis (PN) on abdominal computed tomography (CT) in patients with acute gallstone pancreatitis (GP) and alcohol-induced pancreatitis (AIP). Methods Patients ≥ 18-year-old with first-time onset of GP, AIP and PN on CT scan, from January 2010 to September 2018, were included. Extent of PN on CT, organ failure rate, admission to the intensive care unit (ICU), were compared between GP (group 1) and AIP (group 2). PN extent was described as: localised – right or left of the midline; diffuse – across the midline; more/less than 50% of the pancreas. Analysis of continuous and categorical data and multiple logistic regression were conducted. Significance was set at p&amp;lt;0.05. Results One hundred-two consecutive patients, 66 in group 1, 36 in group 2, were included. Overall, diffuse PN occurred in 34.3% of cases, more frequently in group 1 (42.4% vs 19.4%, p=0.03). Single/multiorgan failure developed in 50 patients, 57.6% belonged to group 1 (p=0.03). Predictors of organ failure were diffuse pattern of PN (OR 2.70, 95% CI 1.03 to 7.03, p=0.004) and PN ≥50% (OR 5.50, 95% CI 1.39 to 21.6, p=0.01). Admission to ICU was required in 27 subjects; PN ≥50% predicted ICU admission (OR 8.93, 95% CI 2.68 to 29.73, p=0.0004). The median hospital stay was 12 days (range 1-265), longer in group 1 (12.5 vs 10.5, p=0.02). Conclusions Diffuse PN occurred more frequently in patients with GP. A larger extent of PN predicted the onset of single/multiorgan failure and admission to the ICU.

FTP6.5 A review of a District General Hospital's performance in meeting Emergency Cholecystectomy guidelines

Abstract Aims Due the Covid pandemic and resultant decrease in elective cholecystectomies there has been an increase in the emergency presentation of gallstone disease to our DGH. The NICE guidelines recommend &amp;gt;25% of Acute Cholecystitis (AC) should receive emergency cholecystectomy on admission and the AUGIS Commissioning Guide: Gallstone Disease 2016 recommends all patients with mild Gallstone Pancreatitis should have an emergency cholecystectomy on admission or within two weeks of discharge. We wanted to see was our department meeting these guidelines. Methods 187 patients identified with AC and pancreatitis from admission records over a three month period. Review of online records narrowed this down to 53 patients with AC (without secondary complications i.e. perforation, Mirizzi) and 18 with Gallstone Pancreatitis. We followed these patients up over a six month period. Results AC patients: 28% (15) were deemed high risk or not suitable (13: &amp;gt;75yo), 26% (14) emergency cholecystectomy on admission, 23% (12) awaiting clinic/ pre-assessment, 7.5% (4) Elective surgery (3 had readmissions pre elective surgery), 7.5% (4) surgery on readmission, 7.5% (4) opted out of surgery. Separately, 24.5% (13) readmitted with gallstone disease. Gallstone Pancreatitis 44% (8) deemed not suitable (4: &amp;gt;85yo, 4: multiple co-morbidities), 33.3% (6) emergency cholecystectomy on admission and 1 each: severe pancreatitis/ opted out/ done on readmission (2.5months later)/ done privately. Conclusions Our DGH is hitting the target for emergency cholecystectomies although the majority of patients presenting with AC are not suitable for surgery and there is a high readmission rate for gallstone disease. Improvement required in following up patients with gallstone pancreatitis not receiving surgery on admission.

FTP5.7 Championing Benign Biliary Patients in a UGI Tertiary Referral Cancer Centre. Results from a 3 year Quality Improvement Project

Abstract Background A biliary quality improvement project (QuIP) was established in 2019 following 3 audit cycles highlighting delays to laparoscopic cholecystectomy (Lap-C) in patients with gallstone pancreatitis. Limited theatre space and prioritisation of high volume cancer work hindered previous efforts to improve the service between 2015 and 2019. The latest phase of the QuIP has introduced a dedicated consultant lead biliary service, a live biliary admission tracking system, increased in-patient Lap-C, implementation of ambulatory pathways and a patient centred integrated care approach. Methods Prospectively collected data from a live biliary tracking system was compared with retrospective audit data from 2015-2019. Key performance indicators were; average time to Lap-C, rate of Lap-C with-in 2 weeks following pancreatitis, inpatient Lap-C rate and out-patient appointments saved. Results 343 patients were managed through inpatient and ambulatory biliary pathways from November 2021-2022. 2 week Lap-C post pancreatitis improved from 27% to 69% (41% as inpatients) with average time to Lap-C improving from 68 days to 13 days. 103 outpatient appointments were save by counselling and pre-assessing patients for Lap-C as inpatients, saving £12360 in outpatient costs. In-patient Lap-C rate improved from 2% to 19% for fit and consenting patients. Conclusion Patients with biliary pathology may be at risk of lower standards of care when treated in centres with a high tertiary UGI cancer burden. A higher quality of care can be achieved for biliary patients through effective patient prioritisation, increasing inpatient Lap-C, the establishment of ambulatory pathways and a robust outpatient tracking system.

WTP3.12 Value of magnetic resonance cholangiopancreatography (MRCP) in acute gallstone pancreatitis

Abstract Aims Magnetic resonance cholangiopancreatography (MRCP) is commonly performed in acute pancreatitis to rule out bile duct stones (BDS). The aim of this study was to determine if MRCP is required to rule out BDS in patients admitted with gallstone pancreatitis (GS). Method A retrospective cohort study of all consecutive MRCPs in a single surgical unit from October 2021 to September 2022 was conducted. Patient demographics, laboratory results and MRCP result data was analysed. Patients with MRCP proven BDS were compared to those without. Results Sixty-one patients were identified, 39 (63.9%) were female. Median age was 62 years (IQR 45-75) and median Scottish Index of Multiple Deprivation was 4 (IQR 3-7). 55 (90.2%) MRCPs were inpatient and 30 (49.2%) were urgent requests. Median wait time for inpatient MRCP was 1 day (IQR 0.7-1.8) and 17.1 days (IQR 14.6-28.3) for outpatient requests. 14 (23%) patients had BDS proven on MRCP. Of these, 6 (42.8%) had evidence of dilated bile ducts on preceding imaging and 8 (57.1%) had hyperbilirubinaemia and raised alkaline phosphatase levels. Median wait time for MRCP for patients with BDS was 0.8 days (IQR 0.35-1.5) compared to 1.2 days (IQR 0.85-2.85) in MRCPs with no evidence of BDS. Conclusion We conclude that MRCP is not required for low-risk patients with acute gallstone pancreatitis. However, MRCP will be beneficial in patients with jaundice and preceding radiological evidence of ductal dilatation. Intraoperative cholangiography is recommended in patients who proceed to laparoscopic cholecystectomy where MRCP has not been performed.

SP7.5 Should we analyse all cholecystectomy specimens? An analysis of the features of incidentally discovered gallbladder cancers

Abstract Aims Gallbladder cancer is the commonest form of malignancy of the biliary tract, but is rare in Western countries. A large proportion of cases are incidentally diagnosed at surgery or from the cholecystectomy specimen. The analysis of gallbladder specimens costs our health board around £42,000 per year. The aim was to identify any predictive factors in incidentally discovered gallbladder cancers. Methods All gallbladder specimen reports at our health board between May 2012 and September 2022 were analysed and filtered so incidental cancer cases could be analysed for any predictive features. Outcomes with only dysplasia were removed. Results 16,695 eligible reports were analysed of which 32 had malignant outcomes. The median age for malignancy was 71 vs 50 for benign. 30 were adenocarcinoma and 2 were adenosquamous carcinoma. 14 presented with cholecystitis, 9 with biliary colic, 6 with choledocholithiasis and 3 with gallstone pancreatitis. Intraoperatively, 7 had normal appearances, 20 were reported at being ‘thickened’, 2 ‘contracted’, 2 with empyema and 1 with a mucocoele. 6 patients had a subtotal cholecystectomy and in all cases this was due to intraoperative difficulty. Conclusions We could not identify any single feature that predicted or excluded the presence of cancer. Given that the lower age limit for malignancy was 51, a consideration could be made for not processing specimens from patients under the age of 45 as the likelihood of diagnosing incidental carcinoma is extremely unlikely and would reduce the yearly processing by 37% with a cost saving of £15,500 per year.

ThTP5.1 Laparoscopic cholecystectomy on index admission – are we following AUGIS guidelines?

Abstract Background Laparoscopic cholecystectomy is the gold standard in management of acute cholecystitis, biliary colic and gallstone induced pancreatitis. AUGIS has produced guidelines recommending optimal timing during index presentation for surgery. Aim To identify if our local acute surgical unit was following AUGIS guideline recommendations and performing laparoscopic cholecystectomy on index admission for recurrent/ongoing biliary colic, mild gallstone pancreatitis and for acute cholecystitis within 72 hours of onset of symptoms. Methods Prospective review of surgical patients admitted to DGH in Northern Ireland with acute cholecystitis, biliary colic and gallstone pancreatitis over six-month period between April and September 2021. Results 103 patients were admitted during 6 months with gallstone disease. Of these, only 20 underwent inpatient lap cholecystectomy during their admission. 21 patients were deemed unfit for surgery and 3 declined surgery. 10 patients with acute cholecystitis had surgery; only 4 had symptom onset within 72 hours as recommended. Conclusion This unit was not following AUGIS recommendations on the timing of laparoscopic cholecystectomy for patients presenting with gallstone disease. During this data collection a pathway was started for day case laparoscopic cholecystectomy at a satellite site to help expedite patients who were unable to have their operation as inpatient.

FTP5.8 Gall bladder service developments to improve outcomes based on national guidelines

Abstract Introduction Nationally, acute gallstone disease accounts for over 1/3rd of emergency general surgery admissions and referrals. Guidelines recommend laparoscopic cholecystectomy within 1 week for acute cholecystitis, on index admission for acute gallstone pancreatitis and within 18 weeks for uncomplicated gallstone disease. Presently, NHS Trusts struggle to meet these targets due to unrelenting demand for limited resources. We present interventions to improve a laparoscopic cholecystectomy service which nearly halved the elective surgery waiting time. Method Retrospective data was collected on patients who underwent elective laparoscopic cholecystectomy at a DGH pre- and post-intervention (March-July 2021 &amp; January-April 2022). Data collected from electronic medical records included patient demographics, waiting list times, operation details and post-operative outcomes. Interventions included introduction of a boarding card which included Cholecystectomy As A Day-case (CAAD) scoring and laparoscopic cholecystectomy standard operating procedure (SOP). The SOP specified criteria for preoperative investigations, theatre list organisation, post-operative admission and high-risk patients requiring specialist surgeon input. Results Pre-intervention cycle included 82 patients, with 78 patients booked as day-case operations and 40.2% unplanned postoperative admissions rate. The post-intervention period assessed 72 patients, with 46 patients booked as day-cases and 30.6% unplanned postoperative admissions. The median day-case LOS remained at 0 days pre- and post-intervention. Median elective laparoscopic cholecystectomy waiting time significantly decreased from 140 to 75 days (p&amp;lt; 0.0001). Conclusion Our study demonstrates interventions to restructure a laparoscopic cholecystectomy service significantly shortened waiting times, with national targets of 18-week wait for uncomplicated gallstone disease surgery met. Additionally, fewer unplanned postoperative admissions allows better bed management therefore reducing disruption to elective and emergency service delivery.

WTP3.11 The impact of inpatient Magnetic Resonance Cholangiopancreatography on total length of hospital stay

Abstract Aims Magnetic resonance cholangiopancreatography (MRCP) is a frequently performed inpatient imaging modality to rule out bile duct stones (BDS). The aim of the study was to quantify the time delays from request of MRCP to its execution. Methods A retrospective cohort study of all consecutive adult inpatient MRCPs was conducted in a single centre from October 2021 to September 2022. Patient demographics, indications for MRCP, system timestamps for MRCP scans and length of stay (LOS) were analysed. Peak liver function test values were used pre-MRCP. Results A total of 302 patients were identified, 181 (59.9%) were female. Median age was 65 (IQR 50-76) and median Scottish Index of Multiple Deprivation score was 5 (IQR 3-8). 59 (19.5 %) MRCPs were performed for jaundice and 55 (18.2 %) were for gallstone pancreatitis. 104 (34.3%) had proven bile duct stones (BDS). Ultrasound and/or CT evidence of dilated bile ducts was strongly correlated with positive MRCP findings (p&amp;lt;0.001). Patient age, gender, bilirubin and alkaline phosphatase levels were not predictive for BDS. 112 (37.1%) were urgent requests. The median wait time for urgent MRCP was 1.0 days (IQR 0.6- 1.8) compared to 1.2 days (IQR 0.9- 2.7) for routine requests. Median LOS was 5.9 days (IQR 3.6-10.9). Conclusion Inpatient MRCP does not significantly impact total LOS. We conclude that patients with high risk factors for BDS should undergo MRCP as inpatients to mitigate complications of BDS.