Biliary Pancreatitis Patients Research Articles

Risk factors of negative diagnosis of MRCP in acute biliary pancreatitis patients with choledocholithiasis.

Assessment of the presence of choledocholithiasis is crucial among acute biliary pancreatitis (ABP). Magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasonography (EUS) are widely used to identify the gallstones of common bile duct (CBD). EUS provides better diagnostic accuracy and sensitivity than MRCP but carries a certain risk due to sedation. We investigated the risk factors of negative diagnosis of MRCP in ABP patients with choledocholithiasis for better selection of MRCP or EUS. A total of 2321 ABP patients were retrospectively included in this study. Based on the exclusion criteria, 337 ABP patients with negative MRCP results were ultimately included. Among these patients, 75 patients had positive EUS findings. Univariate and multivariate logistic regression models were used to screen the risk factors of negative diagnosis of MRCP in ABP patients with choledocholithiasis. Patients with positive EUS findings were older (62.0 vs. 55.0) and had higher rate of cholecystectomy history (18.7% vs. 7.3%) than those with negative EUS findings. The result of univariate logistic regression showed that the history of cholecystectomy, age and sex were potential risk factors (all p < 0.05). Then after adjusting the other potential risk factors (Direct bilirubin (DBIL), alanine transaminase (ALT), gamma-glutamyl transpeptidase (GGT) and alkaline phosphatase (ALP)), a history of cholecystectomy (OR = 2.859 [1.312,6.23]), older age (1.03 [1.009,1.052]) and male (2.016 [1.152,3.528]) were independent risk factors of negative diagnosis of MRCP in ABP patients with choledocholithiasis. The history of cholecystectomy, older age and male are independently associated with an increased risk of negative diagnosis of MRCP in ABP patients with choledocholithiasis. We suggest that patients with these risk factors should undergo EUS first, rather than MRCP.

Current Diagnosis and Treatment of Acute Pancreatitis in Korea: A Nationwide Survey.

Acute pancreatitis (AP) is a leading cause of emergency hospitalization. We present the current diagnostic and therapeutic status of AP as revealed by analysis of a large multicenter dataset. The medical records of patients diagnosed with AP between 2018 and 2019 in 12 tertiary medical centers in Korea were retrospectively reviewed. In total, 676 patients were included, of whom 388 (57.4%) were male, and the mean age of all patients was 58.6 years. There were 355 (52.5%), 301 (44.5%), and 20 (3.0%) patients with mild, moderate, and severe AP, respectively, as assessed by the revised Atlanta classification. The most common etiologies of AP were biliary issues (41.6%) and alcohol consumption (24.6%), followed by hypertriglyceridemia (6.8%). The etiology was not identified in 111 (16.4%) patients at the time of initial admission. The overall mortality rate was 3.3%, increasing up to 45.0% among patients with severe AP. Notably, 70.0% (14/20) of patients with severe AP and 81.5% (154/189) of patients with systemic inflammatory response syndrome had received <4 L per day during the initial 24 hours of admission. Only 23.8% (67/281) of acute biliary pancreatitis patients underwent cholecystectomy during their initial admission. In total, 17.8% of patients experienced recurrent attacks during follow-up. However, none of the patients with acute biliary pancreatitis experienced recurrent attacks if they had undergone cholecystectomy during their initial admission. This study provides insights into the current status of AP in Korea, including its etiology, severity, and management. Results reveal disparities between clinical guidelines and their practical implementation for AP treatment.

Is Routine Intraoperative Cholangiogram Necessary in Patients With Mild Acute Biliary Pancreatitis Undergoing Index Admission Cholecystectomy?

Background: There is controversy about whether intraoperative cholangiogram (IOC) should be performed routinely during laparoscopic cholecystectomy for patients with acute biliary pancreatitis, given significant false positive and negative rates and increased resource utilization. The aim of this study was to clarify the role of IOC in cases of mild biliary pancreatitis in patients undergoing index admission cholecystectomy, its impact on patient outcomes, and the impact of blood tests, imaging, and preoperative intervention on the detection of choledocholithiasis.Methods: A retrospective review of all patients presenting with acute mild biliary pancreatitis between January 2006 and December 2019 was conducted. Data collected included patient demographics, serum chemistry, IOC, and Endoscopic Retrograde Cholangiopancreatography (ERCP) findings, imaging findings, length of stay, operative length, and long-term follow-up outcomes.Results: 284 patients met the inclusion criteria for the study. The overall false positive IOC rate was 7.4%. Worsening bilirubin trend was a positive predictive value (PPV) for positive IOC and ERCP outcomes with a relative risk of 2.93 (P < .01) and 2.32 (P = .013), respectively. Improving preoperative bilirubin trend had a significant negative predictive value in IOC with a relative risk of .59 (P = .02). Positive IOC was shown to significantly increase operative length with a relative risk of 2.03 (P < .001).Discussion: A rising preoperative bilirubin is a predictor of a positive IOC and patients with normalizing bilirubin levels or a preoperative ERCP are less likely to have choledocholithiasis. These features may be used to select patients that would benefit from an IOC for index admission cholecystectomy.

S36 Early Cholecystectomy Improves Clinical Outcomes in Acute Biliary Pancreatitis Patients Across All Age Groups: A Multicenter Retrospective Study

S36 Early Cholecystectomy Improves Clinical Outcomes in Acute Biliary Pancreatitis Patients Across All Age Groups: A Multicenter Retrospective Study

Лікування та профілактика печінкової дисфункції при гострому панкреатиті біліарної етіології у хворих на цукровий діабет

Мета роботи — оцінка ефективності традиційних та оптимізованих програм комплексного лікування та профілактики клініко-лабораторних проявів печінкової дисфункції при гострому панкреатиті біліарної етіології у хворих на цукровий діабет шляхом спостереження динаміки маркерів цитопатичної гіпоксії, системи еритрону та обміну заліза. Матеріали та методи. Робота побудована на аналізі результатів комплексного лікування 122 хворих на цукровий діабет, у яких виник гострий панкреатит біліарної етіології (ГПБЕ). Лабораторний аналіз здійснювався в межах моніторингу маркерів цитопатичної гіпоксії, системи еритрону та обміну заліза залежно від морфологічної форми гострого панкреатиту та ефективності оптимізованого та традиційного лікування. Результати. Інтерстиційна форма гострого панкреатиту біліарної етіології в умовах цукрового діабету характеризується вірогідними змінами динаміки карбонільних груп, умісту аргініну та аденозиндезамінази на фоні фізіологічних коливань решти досліджуваних маркерів цитопатичної гіпоксії, констатовані ознаки вираженого функціонального залізодефіцитного стану у вигляді мікроцитозу та гіпохромії. Виникнення некрозу паренхіми підшлункової залози різної площини залежно від морфологічної форми гострого панкреатиту біліарної етіології супроводжується вірогідними ознаками абсолютного залізодефіцитного стану різного ступеня інтенсивності та негативною динамікою показників ендотеліальної дисфункції при відокремленій формі. У хворих на поширений некротичний гострий біліарний панкреатит у патологічні зрушення системного метаболізму долучається катаболізм пуринових нуклеотидів — відбувається зростання рівнів ксантину та гіпоксантину. Стадія декомпенсації системних порушень гомеостазу спостерігається у хворих із субтотально-тотальними формами, коли додатково діагностується зростання концентрацій ферментів, що відповідальні за утилізацію продуктів катаболізму пуринових нуклеотидів (ксантиноксидаза, ксантиндегідрогеназа), які здатні до продукції реактивних форм кисню, стимулюючи оксидативний стрес. Висновки. Перебіг ГПБЕ у хворих із цукровим діабетом супроводжується закономірними змінами маркерів синдрому цитопатичної гіпоксії, системи еритрону та обміну заліза, ступінь тяжкості цих порушень має пряму кореляцію з площею морфологічних змін у підшлунковій залозі та динамікою маркерів печінкової недостатності, що дозволяє використовувати їх як прогностичні та диференціально-діагностичні критерії. За допомогою методів протокольної терапії не можна усунути наявні метаболічні порушення, а це вимагає включення до стандартних схем консервативного лікування набрякової форми ГПБЕ системного поліфункціонального метаболічного коректора (препарат Берлітіон®) для системної превентивної корекції гомеостазу та механізмів ескалації проявів печінкової дисфункції, що за наявності деструктивних форм вимагають додаткового застосування групи низькомолекулярних гепаринів (препарат Цибор®) для відновлення гемореологічних та гемокоагуляційних порушень на системному та інтраорганному рівнях

Endoscopic Sphinterotomy in Patients with Mild Acute Biliary Pancreatitis, in &amp;lt;i&amp;gt;Situ&amp;lt;/i&amp;gt; Gallbladder and Alithiasic Bile Duct: Is It Justified?

Objective: To compare the long-term results of the treatment of mild acute biliary pancreatitis in patients with gallbladder in situ, without stones in the bile duct, treated by cholecystectomy, and endoscopic sphincterotomy (ES) versus simple cholecystectomy in the prevention of recurrence of this pathology. Material and Methods: Between May 2008 and December 2012, 110 consecutive patients with a mild acute biliary pancreatitis (ABP) were prospectively studied. None had undergone cholecystectomy, and choledocholithiasis was ruled out by ERCP. Two groups of patients were created and randomized: Group I (n = 55) who underwent ERCP plus ES and Group II (n = 55) only had diagnostic ERCP. Patients were then referred for cholecystectomy. Follow up was completed in 101 patients. Group I was made up of 53 patients and Group II had 48 similar characteristics. Patients were followed for an average of 105 months. At the end of the follow-up, 12 (22.6%) from Group I and 6 (12.5%) from Group II (p = 0.143) remained with the gallbladder in situ. Results: There were 53 patients in Group I (100%). Only 42 (87.5%) of those in Group II evolved without biliopancreatic complications (p = 0.0096). In the latter, 6 (12.5%) were complicated, and 5 had not had cholecystectomy. In Group I patients, there was no recurrence of acute biliary pancreatitis, but this was seen in 4 cases (8.4%) in Group II (p = 0.0476). Group I also had 2 cases of biliary colic (4.2%) and 2 cases of obstructive jaundice (4.2%). Conclusions : The risk of recurrence is significant in patients with mild acute biliary pancreatitis, without bile duct stones, and in whom cholecystectomy is not performed; thus, an ES is recommended.

The relationship between lymphopenia and development of late complications in severe acute pancreatitis.

In this study we aimed to predict patients who would develop late stage acute pancreatitis related complications. So we would be able to ease the decision making process about the timing of cholecycstectomy. On the other hand we also suggest a possible insight into the mechanisms which lead development of lyphopenia in severe acute pancreatitis and its possible effects on prognosis. In this study, 163 severe acute pancreatitis case who has been treated as inpatient between January 2013 and January 2018 has been involved. Patients charts and all documented data has been analysed retrospectively. According to the existence or absence of late complications of severe acute pancreatitis, patients have been divided into two groups; Group 1 had no late complication, Group 2 had either pseudocyst or WON (Walled of Necrosis) at 1st month CT. The difference between two groups in terms of 48th hour lymphocyte percentage was significant (p=0.000; p<0.05). Group 2 had remarkably longer duration of hospital stay (p=0.000; p<0.05). 48th hour CRP level of group 2 was significantly higher than of group 1 (p<0.000). There is a statistically significant relation between the presence of lymphopenia, at 48th hour of presentation in severe biliary pancreatitis patients and development of delayed complications. We can strongly say that there would be no late term pancreatitis related complications if there was no lymphopenia at 48 hour and an early cholecystectomi can be performed in such cases. Lymphopenia seen around 48. hr of admission is highly related to development of late complications in severe acute pancreatitis.

S0113 The Timing of Endoscopic Retrograde Cholangiopancreatography in Acute Biliary Pancreatitis Without Cholangitis: A Nationwide Inpatient Cohort Study

INTRODUCTION: Endoscopic Retrograde Cholangiopancreatography (ERCP) is recommended within 24 hours for patients with Acute biliary pancreatitis (ABP) with signs of cholangitis. In the absence of cholangitis, the impact of the timing of ERCP remains unclear. We aimed to analyze the timing of ERCP in ABP patients without cholangitis. METHODS: This is a retrospective, longitudinal study of patients from 2005 to 2014, who presented to the US hospitals with diagnosis of ABP and received ERCP within first 24 hours (urgent ERCP) or within 24 to 72 hours (early ERCP). Study cohort was extracted from the Nationwide Inpatient Sample database. Hospital ERCP volumes were generated using unique hospital identifiers. Multivariate regression modeling was used to analyze the predictors of urgent vs. early ERCP use, and to determine various outcome variables between the two cohort. RESULTS: Overall, 105,433 admissions were evaluated. There was a significant P-trend (P < 0.001) increase in urgent ERCP performed over the 10-year study period (Figure 1). Predictors of urgent ERCP in ABP patients utilizing multivariate regression model are shown in Figure 2. Older patients, males, patients with comorbidities, African American and Hispanic patient population were significantly less likely to receive ERCP urgently. Intermediate ERCP volume hospitals were more likely to perform urgent ERCP in ABP patients. Additionally, teaching hospitals and hospitals in the Midwest and West were more likely to perform urgent ERCP. Use of abdominal imaging modalities prior to ERCP resulted in 50% decrease in the utilization of urgent ERCP. There were no differences in mortality rates or the complications rates between the two cohorts (Table 1). The composite variable encompassing all the complications was not significant between the two groups. There were significant differences in length of stay and healthcare cost analysis. CONCLUSION: We performed a retrospective study of patients with ABP (but without cholangitis) that showed an increasing trend of urgent ERCP over the study period without clinically significant benefit in mortality, length of stay and healthcare cost analysis. Further, urgent ERCP utilization is not uniform across various demographic and hospital cohorts. Hence, early ERCP may be over-utilized, and it may be reasonable to perform early ERCP (within 24–72 hours) instead of urgent ERCP in ABP patients in the absence of cholangitis.Figure 1.: Trends of urgent ERCP utilization in Acute Biliary Pancreatitis patients without signs of cholangitis across a 10-year period from 2005 to 2014.Figure 2.: Multivariate regression model predicting demographic and hospital factors affecting urgent ERCP utilization in Acute Biliary Pancreatitis without signs of cholangitis.Table 1.: Mutivariate Hazard Ratios and Regression Coefficients of various outcome factors based on patients receiving urgent ERCP in Acute Biliary Pancreatitis patients without signs of cholangitis compared to patients receiving early ERCP

Non-inferiority comparative clinical trial between early oral REFEEDING and usual oral REFEEDING in predicted mild acute biliary pancreatitis

BackgroundThe aim of the study was to compare the onset of oral feeding in the first 24 h after hospital admission with usual oral refeeding and determine whether the timing of the onset of oral feeding influences the recurrence of pain or alters the blood levels of pancreatic enzymes in patients with predicted mild acute biliary pancreatitis.MethodsThis non-inferiority randomized controlled trial was carried out between September 2018 and June 2019 after receiving authorization from the ethics committee for health research. Patients with a diagnosis of predicted mild acute biliary pancreatitis were divided into Group A (early oral refeeding, EOR) and Group B (usual oral refeeding, UOR). Outcome measures included pancreatic lipase levels, the systemic inflammatory response (concentrations of leukocytes), feasibility (evaluated by abdominal pain recurrence), the presence and recurrence of gastrointestinal symptoms and the length of hospital stay.ResultsTwo patients in the EOR group experienced pain relapse (3.2%), and four patients in the UOR group experienced pain relapse (6.77%) after oral refeeding (p = 0.379). The presence of nausea or vomiting after the onset of oral refeeding was not different between the two groups (p = 0.293). The onset of oral refeeding was approximately 48 h later in the UOR group. The length of hospital stay was 5 days in the EOR group and 8 days in the UOR group (p = 0.042), and this difference was also manifested in higher hospital costs in the UOR group (p = 0.0235).ConclusionCompared with usual oral refeeding, early oral refeeding is safe in predicted mild acute biliary pancreatitis patients, does not cause adverse gastrointestinal events, and reduces the length of hospital stay and costs.Trial registrationEarly oral refeeding in mild acute pancreatitis (EORVsUOR). NCT04168801, retrospectively registered (November 19, 2019).

Prognostic Significance of Thiol/Disulfide Ratio in the Diagnosis of Acute Biliary Pancreatitis

To determine changes in thiol/disulfide levels in patients with acute biliary pancreatitis for the first time, and to adapt these data to the clinic during the follow-up period. Evaluation was made of 39 acute biliary pancreatitis patients and 39 healthy control subjects. Amylase, lipase, and thiol/disulfide balance were determined from blood sampling. Prognostic markers were calculated from blood taken in the 48th hour of hospitalization of the patients. The Ranson criteria, APACHE scale, Imrei scale, C reactive protein, and procalcitonin values were calculated as prognostic markers. These were compared simultaneously with thiol/disulfide levels. Amylase and lipase levels were found to be significantly different in the experimental group compared with the control group, but there was no significant difference in the plasma thiol/disulfide balance. A minimally significant relationship was determined between C reactive protein and thiol/disulfide levels in terms of prognostic significance. The study results showed that the plasma thiol/disulfide level did not reveal the severity of acute pancreatitis. There is a need for more comprehensive studies to investigate in more detail the plasma thiol/disulfide balance which demonstrates oxidative stability.

82 A Comparison of Machine Learning and Logistic Regression Performance for the Prediction of In-Hospital Mortality Among Acute Biliary Pancreatitis Patients

INTRODUCTION: For population databases, traditional multivariate analysis is accepted standard for predictive modelling of mortality in acute biliary pancreatitis (ABP). Machine Learning (ML) and artificial intelligence (AI) are novel methodologies to analyze databases. The gradient boosting machine (GBM) is a tree-based ML approach. Tree-based algorithms partition the data based on predictors in an attempt to accurately classify the outcome. The gradient boosting approach employs successive trees to improve upon misclassifications of the earlier trees. Alternatively, logistic regression is a statistical approach, in which predicted probabilities are generated based on parameters estimated by maximum likelihood estimation. With the advent of universal electronic medical records, patient databases are more complex, large, and interlinked to multiple institutions. Hence, we sought to compare traditional statistical methods and ML in building prediction models for mortality in ABP. METHODS: Using the Nationwide Readmission Database (2010–2014), we identified all patients (age &gt; 18 years) with index admissions for ABP. This data was randomly divided into a training set (70%) and a test set (30%), stratified by outcome in order to get similar event rates in both sets. The same training and test sets were used for GBM learning and logistic regression. The area under the ROC curve (AUROC) was calculated for both GBM and logistic regression modelling for predicting mortality in ABP. RESULTS: A total of 97,027 patients were hospitalized for ABP from 2010–2014 in the US. The in-hospital mortality rate was 0.97% (n = 944). Using the same set of predictor variables (demographic, hospital, etiological, comorbidities, severity of acute pancreatitis (AP), procedures, and duration of stay), ML and logistic regression performed similarly in predicting mortality with GBM achieving an AUROC of 0.955 and logistic regression AUROC 0.948 (Figure 1). Key predictors of mortality for AP using logistic regression included: Severe AP, sepsis, increasing age, and failure to perform cholecystectomy. Foremost predictors using GBM included length of stay, age, severe AP and income quartile. CONCLUSION: Notwithstanding emergence of novel AI methodologies, traditional logistic regression is comparable to novel ML algorithms in the predictive modelling of hospital outcomes in ABP and can continue to be utilized in large population databases.

Analysis of operation timing and clinical efficacy of endoscopic retrograde cholangiopancreatography in the treatment of acute biliary pancreatitis

Objective To discuss the operation timing, clinical efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of acute biliary pancreatitis. Methods Retrospective analyzed the clinical data of 65 acute biliary pancreatitis patients in First People′s Hospital of Jiangxia District, Wuhan city form October 2015 to July 2017, there were 45 males and 30 females, the age was (46.35±8.95) years (range, 25-72 years). All patients were treated with ERCP, and divided into 24-72 h group (the time from onset to ERCP treatment 24-72 h) 16 cases, 72-120 h group (the time from onset to ERCP treatment 72-120 h) 25 cases and ≥120 h group(the time from onset to ERCP treatment ≥120 h) 34 cases, recorded and compared the clinical indexes during and after operation, laboratory indexes before and after treatment, incidence of surgical complications, recurrence rate and mortality.The measurement data with normal distribution were expressed as mean±standard deviation (Mean±SD), the F test was used for comparison among the three groups, and the t test was used for comparison between the two groups, the count data were compared by χ2 test, and the rank sum test was used to compare the incidence of surgical complications. Results The abdominal pain relief time, amylase recovery time, length of stay and hospitalization expenses of the 24-72 h group were (4.48±1.29) d, (3.59±1.22) d, (7.24±1.55) d and (1.55±0.31) ten thousand yuan respectively, the 72-120 h group were (7.35±1.76) d, (4.91±1.37) d, (13.61±2.13) d, (2.02±0.37) ten thousand yuan respectively, the ≥120 h group were (11.21±2.02) d, (8.86±1.95) d, (21.58±2.86) d, (2.49±0.52) ten thousand yuan respectively, with significant differences between any two groups(P 0.05). Conclusion In the treatment of acute biliary pancreatitis within 24-72 h and 72-120 h are safe and effective, but the improvement of laboratory indexes within 24-72 h ERCP treatment is more obvious, the length of stay is shorter, the hospitalization expenses is more provincial, and with more clinical advantage. Key words: Cholangiopancreatography, endoscopic retrograde; Pancreatitis; Postoperative complications; Safety

Is There Disparity in Index-Admission Cholecystectomy for Mild Acute Biliary Pancreatitis in Patients With Morbid Obesity: A National Survey

Introduction: Gallstone is the leading cause of acute pancreatitis (AP) and obesity is a risk factor for gallstone formation. Major society guidelines have recommended same admission cholecystectomy (CCY) for mild acute biliary pancreatitis (ABP). There has been reported disparity regarding obese patient receiving standard medical care from routine cancer screening to end of life care. We sought to determine if there is a disparity in performance of index-admission CCY in patients admitted with mild ABP. Methods: The National Readmission Database (2010-2014) was reviewed to identify adult inpatients (≥18years) with a principal diagnosis of ABP (AP with gallstones). Only patients with mild ABP were included. Study flow is shown in Figure 1. The primary outcome was index-admission CCY and secondary outcomes included post-CCY complication, 30-day readmission and hospital cost. Univariate, multivariate, and propensity score-matched analyses was performed to compare the morbidly obese and non-obese cohorts.1023_A Figure 1. Study Flow Chart: Showing exclusion criteria, primary and secondary outcome in the study.Results: There were 150,884 patients (non-obese 136,332, morbid obese 14,552) with mild ABP during the study period. Patients with morbid obesity were younger (46.7 vs 56.3 years, p001), predominantly female (71.6% vs 62.4%, p < .001), and had more comorbidities (32% vs 27.5% p < .001) compared to the nonobese cohort (Table 1). After propensity score-matched analysis, morbid obesity cohort with mild ABP had a higher indexadmission CCY rate (60.9% vs 58.3% p= 0.01), longer hospital stay (3.5 vs 3.2 days p < .001), and higher hospital cost (IQR: $10,237 vs $9,326 p < .001) but similar post-CCY complication rate (2.1% vs 1.9% p=0.13) and 30-day readmission rate (5.4% vs 5.0% p=0.5) compared to the non-obese cohort (Table 1). Conclusion: This national survey demonstrates a lack of disparity in index-admission CCY for patients with morbid obesity when admitted with mild ABP. Further, the clinical outcomes of CCY related post-operative complication and 30-day readmission in patients with morbid obesity are comparable to the non-obese cohort further reinforcing adherence to current guidelines.1023_B Figure 2. Patient Characteristics1023_C Figure 3. Primary and secondary outcomes, propensity score matched

Association between leptin and insulin resistance in biliary acute pancreatitis patients

Association between leptin and insulin resistance in biliary acute pancreatitis patients

TGF-B promotes EMT and metastasis of pancreatic cancer cells through Src and NF-kB pathway-dependent repression of PP2Ac

Population based data on the burden and patterns of acute pancreatitis (AP) early readmissions (≤30-days) are limited.2013 Nationwide Readmission Database (NRD) was queried. AP etiology was determined using associated diagnoses codes. Proportion, reasons for readmission, and associated costs were evaluated. Multivariate logistic regression analysis was performed to identify independent predictors for 30-day readmission.After exclusions, we identified 178,541 patients with primary diagnosis of AP (mean age 53 ± 17 years, 51% male). 13.7% were readmitted ≤30 days [7.1% in acute biliary pancreatitis (ABP) patients with index cholecystectomy (CCY), 16.3% in ABP patients without CCY, and 14.3% in non-biliary AP patients (p < 0.0001)]. Reasons for readmission included AP, chronic pancreatitis, Pseudocyst/walled off necrosis, biliary tract disease, smoldering symptoms and others. On multivariate analysis male gender, comorbidity status (≥3), non-biliary etiology, organ failure, Pseudocyst/walled off necrosis complications, and patients discharged to extended care facilities were associated with increased risk of readmission. ABP patients with index CCY had a significantly lower risk of early unplanned readmission (odds ratio 0.45, p < 0.0001) but ABP patients with index ERCP did not (p = 0.96).About 1 in 7 AP patients had a 30-day readmission after index hospitalization and about half of these were related to AP. Our data confirms the higher risk of readmission in alcohol and idiopathic AP and a lower risk in ABP. Risk of early unplanned readmission is significantly lower in ABP patients who underwent CCY and not ERCP during index hospitalization. Cholecystectomy should be performed in all ABP patients as per recommended guidelines.

Acute biliary pancreatitis in patients with diabetes mellitus: treatment peculiarities and diagnostic programs

Acute biliary pancreatitis in patients with diabetes mellitus: treatment peculiarities and diagnostic programs

Predictors for early readmission in acute pancreatitis (AP) in the United States (US) – A nationwide population based study

Background & AimsPopulation based data on the burden and patterns of acute pancreatitis (AP) early readmissions (≤30-days) are limited. Methods2013 Nationwide Readmission Database (NRD) was queried. AP etiology was determined using associated diagnoses codes. Proportion, reasons for readmission, and associated costs were evaluated. Multivariate logistic regression analysis was performed to identify independent predictors for 30-day readmission. ResultsAfter exclusions, we identified 178,541 patients with primary diagnosis of AP (mean age 53 ± 17 years, 51% male). 13.7% were readmitted ≤30 days [7.1% in acute biliary pancreatitis (ABP) patients with index cholecystectomy (CCY), 16.3% in ABP patients without CCY, and 14.3% in non-biliary AP patients (p < 0.0001)]. Reasons for readmission included AP, chronic pancreatitis, Pseudocyst/walled off necrosis, biliary tract disease, smoldering symptoms and others. On multivariate analysis male gender, comorbidity status (≥3), non-biliary etiology, organ failure, Pseudocyst/walled off necrosis complications, and patients discharged to extended care facilities were associated with increased risk of readmission. ABP patients with index CCY had a significantly lower risk of early unplanned readmission (odds ratio 0.45, p < 0.0001) but ABP patients with index ERCP did not (p = 0.96). ConclusionsAbout 1 in 7 AP patients had a 30-day readmission after index hospitalization and about half of these were related to AP. Our data confirms the higher risk of readmission in alcohol and idiopathic AP and a lower risk in ABP. Risk of early unplanned readmission is significantly lower in ABP patients who underwent CCY and not ERCP during index hospitalization. Cholecystectomy should be performed in all ABP patients as per recommended guidelines.

Treatment of chronic biliary pancreatitis in patients with obesity

Treatment of chronic biliary pancreatitis in patients with obesity

Comparison of Endoscopic Ultrasound (EUS) and Magnetic Resonance Cholangiopancreatography (MRCP) in Diagnosing Cholelithiasis in Acute Biliary Pancreatitis Patients

Aim: To determine how endoscopic ultrasound (EUS) is compared to magnetic resonance cholangiopancreatography (MRCP) in diagnosing cholelithiasis in acute biliary pancreatitis.Method: Five steps of evidence based medicine is conducted, they are: (1) Formulate the clinical question; (2) Search the evidence; (3) Appraise the study; (4) Apply the answer; (5) Assess the outcome. The search term in general is: (“cholelithiasis”) and (“EUS”) and (“MRCP”) and diagnosis.Results: We searched in Pubmed and Cochrane library. We excluded articles that do not focus on answering our clinical question. There is one systematic review that is capable of answering our clinical question.Conclusion: It can generally be concluded from this study that EUS and MRCP are useful techniques in the etiological diagnosis of acute pancreatitis of non-established cause. Endoscopic ultrasonography should be preferred for establishing a possible biliary etiology in patients who have not had a cholecystectomy.

Application of triple nutrition support in acute biliary pancreatitis patients with liver injury

Application of triple nutrition support in acute biliary pancreatitis patients with liver injury