Pancreatitis Research Articles

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<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 >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: >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: >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 & 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< 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<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.

Vitamin D3 analogue calcipotriol inhibits the profibrotic effects of transforming growth factor- β1 on pancreatic stellate cells

ObjectiveTo evaluate the inhibitory effect of vitamin D3 analogue calcipotriol (Cal) on the fibrosis of pancreatic stellate cells (PSCs) induced by TGF-β1 and the rationality of Cal use in alcoholic chronic pancreatitis (ACP). Material and methodsDouble-labeling immunofluorescence was used for the identification of VDR+PSCs in the pancreas of healthy controls (HC) and ACP patients. Van Gieson staining for examination of collagen fibers. RT-qPCR and Western Blot for determining the mRNAs and proteins of VDR, TGF-β1 and COL1A1 in the pancreas of ACP or in vitro PSCs. ELISA or LC-MS/MS for detection of serum TGF-β1 and COL1A1 or 25(OH)D3. The PSC line (RP-2 cell) was used for the determination of proteomic alterations in Cal plus TGF-β1 versus TGF-β1 and to examine the effect of VDR gene knockdown. ResultsEnhanced expression of VDR was detected in RP-2 cells stimulated with alcohol (ALC) plus Cal versus Cal alone and in PSCs in the pancreas of ACP versus HC. The increased VDR+PSCs were positively correlated with the levels of COL1A1 mRNAs or areas of collagen deposition in the pancreas of ACP. TGF-β1 was overexpressed in the pancreas of ACP and ALC-treated RP-2 cells while 25(OH)D3 level in serum was significantly decreased in ACP versus HC. Through a VDR-dependent mechanism, Cal antagonized 16 profibrotic proteins in TGF-β1-induced RP-2 cells that included 7 extracellular matrix components, 2 cytoskeletal proteins, 2 fibrosis-associated factors (RUNX1 and TRAF2), TIMP-1, CCN1, integrin α11, an adhesion scaffold protein (TGFB1i1) and an enzyme mediating TGF-β1-induced fibrogenesis (ENPP1). ConclusionThis study suggests that Cal administration may be a potential antifibrotic strategy via inhibiting TGF-β1-mediated PSC action during the development of ACP.

Post-healing perceptions and experiences of alcohol withdrawal and life management in men with alcoholic pancreatitis: a qualitative study.

The aim of this study was to examine the perceptions and experiences of male patients with alcoholic pancreatitis after healing regarding alcohol withdrawal and life management. This study used a qualitative descriptive design, and participants were selected by purposive sampling from two tertiary care hospitals in Shandong Province, China. Semi-structured in-depth interviews were conducted with 18 male patients discharged from the gastroenterology department who had recovered from alcoholic pancreatitis. Colaizzi's method was used to analyze the interview data, and the findings were reported using COREQ criteria. By analyzing the interview data, we summarized five themes, (1) the dilemma of sobriety, (2) role change, (3) illness status, (4) family influence, and (5) life management. By profiling the perceptions and experiences of post-healing alcoholic pancreatitis patients' alcohol cessation and life management in men, it helps to grasp the details of alcohol cessation and health direction of patients' home management, which provides more directional guidance to help patients maintain positive and good lifestyle habits and active management awareness, followed by targeted personalized interventions to provide patients with knowledge of disease care and health management.

Impact of the COVID-19 Pandemic on the Management of Gallbladder, Biliary Tract, and Pancreatic Diseases.

Introduction Biliary diseases are a major acute general surgical burden. Laparoscopic cholecystectomy is the gold standard surgical procedure, although it was discontinued during an outbreak. Effective management permits decisive therapy, symptom alleviation, and fewer hospitalizations and complications. Throughout the initial COVID-19 situation, surgical procedures for patients were delayed. Invasive services were required to employ conservative or non-operative therapy, which could lead to increased recurring presentations and biliary-pancreatic problems. Aim Examining the impact of COVID-19 on the outcomes and hospitalizations of patients suffering from gallstone, biliary tract, and pancreatic diseases. Methods The retrospective analysis included patients with the following ICD-10 codes who presented to our unit: cholelithiasis (K80), cholecystitis (K81), and acute pancreatitis (K85). We compared the interval of the first COVID-19 pandemic wave, from March to August 2020, with the period before the pandemic, referred to as Pre-COVID-19. After applying exclusion criteria, a total of 868 patients were enrolled in the trial, having initially recruited around 1,400 individuals using these codes. Patients with inaccurate coding, cancer, or non-stone disease were excluded (e.g., alcoholic pancreatitis). The demographic information, admission details, investigations, surgical therapy, operating specifics, and postoperative complications of the patients were noted. Changes in surgical management, patient representation, and postoperative complications were the key outcomes. Results A statistically significant (p<0.05) rise was seen in repeat presentations in the COVID group, most likely due to the failure of definitive treatment. The other outcome is the distribution of presentations was comparable, patients with acute cholecystitis and gallstone pancreatitis showed statistically significant (p<0.05) lower rates of definitive therapy. Conclusion During the COVID period, all surgeries except those for cancer were halted. Unknown causes led to several consequences related to the gallbladder, biliary tract, and pancreas. Patients with cholecystitis, gallstone pancreatitis, and pancreatic inflammation experienced a lower probability of treatment. The increase in hospitalizations and self-presentations indicated that definitive therapy, designed to restrict COVID-19 exposure, actually increased patient risk. Despite this risk, we had no COVID-19 instances in our cohort. The evaluation of the long-term consequences of the pandemic on acute pancreatitis and its care will require a large-scale, multicenter investigation.

Retained stone retrieval basket causing chronic pancreatitis: a case report.

Endoscopic retrograde cholangiopancreatography is a common procedure performed for choledocholithiasis and gallstone pancreatitis. Although a relatively low risk procedure, it is not without its complications. Cases of impacted Dormia baskets during stone retrieval have been reported, but these are usually retrieved surgically during the same setting. A 40-year-old man presented to our hospital with an episode of epigastric pain and discomfort. He has a prior background of recurrent episodes of pancreatitis of which he underwent prior endoscopic therapy in his home country. Initial investigations revealed a metallic object seen on abdominal x-ray, computer tomographic scan of the abdomen and pelvis, and magnetic resonance imaging of the pancreas. Further evaluation was done with endoscopy, which revealed a retained stone extraction basket from a previous endoscopic retrograde pancreatography, resulting in recurrent episodes of acute chronic pancreatitis. Although the retained foreign body was removed, he subsequently developed further complications of portal vein thrombosis as a result of recurrent acute chronic pancreatitis, which required anticoagulation. This case highlights the importance of retrieving any foreign body from the pancreas, especially on the head, to prevent the development of further complications.

Restoration of PITPNA in Type 2 diabetic human islets reverses pancreatic beta-cell dysfunction

Defects in insulin processing and granule maturation are linked to pancreatic beta-cell failure during type 2 diabetes (T2D). Phosphatidylinositol transfer protein alpha (PITPNA) stimulates activity of phosphatidylinositol (PtdIns) 4-OH kinase to produce sufficient PtdIns-4-phosphate (PtdIns-4-P) in the trans-Golgi network to promote insulin granule maturation. PITPNA in beta-cells of T2D human subjects is markedly reduced suggesting its depletion accompanies beta-cell dysfunction. Conditional deletion of Pitpna in the beta-cells of Ins-Cre, Pitpnaflox/flox mice leads to hyperglycemia resulting from decreasing glucose-stimulated insulin secretion (GSIS) and reducing pancreatic beta-cell mass. Furthermore, PITPNA silencing in human islets confirms its role in PtdIns-4-P synthesis and leads to impaired insulin granule maturation and docking, GSIS, and proinsulin processing with evidence of ER stress. Restoration of PITPNA in islets of T2D human subjects reverses these beta-cell defects and identify PITPNA as a critical target linked to beta-cell failure in T2D.

Blood and bile: A gastroduodenal artery pseudoaneurysm associated with endoscopic retrograde cholangiopancreatography stent migration

A man in his mid-forties presented with a two-day history of sudden onset right upper quadrant pain and coffee-ground vomiting. Eight months previously, he underwent successful endoscopic retrograde cholangiopancreatography (ERCP) with biliary stenting for cholangitis and severe gallstone pancreatitis. This was followed by a COVID-delayed uncomplicated laparoscopic cholecystectomy.

Ethanol inhibits pancreatic acinar cell autophagy through upregulation of ATG4B, mediating pathological responses of alcoholic pancreatitis.

Excessive alcohol intake is a major risk factor for pancreatitis, sensitizing the exocrine pancreas to stressors by mechanisms that remain obscure. Impaired autophagy drives nonalcoholic pancreatitis, but the effects of ethanol (EtOH) and alcoholic pancreatitis on autophagy are poorly understood. Here, we find that ethanol reduces autophagosome formation in pancreatic acinar cells, both in a mouse model of alcoholic pancreatitis induced by a combination of EtOH diet and cerulein (a CCK ortholog) and in EtOH+CCK-treated acinar cells (ex vivo model). Ethanol treatments decreased pancreatic level of LC3-II, a key mediator of autophagosome formation. This was caused by ethanol-induced upregulation of ATG4B, a cysteine protease that, cell dependently, regulates the balance between cytosolic LC3-I and membrane-bound LC3-II. We show that ATG4B negatively regulates LC3-II in acinar cells subjected to EtOH treatments. Ethanol raised ATG4B level by inhibiting its degradation, enhanced ATG4B enzymatic activity, and strengthened its interaction with LC3-II. We also found an increase in ATG4B and impaired autophagy in a dissimilar, nonsecretagogue model of alcoholic pancreatitis induced by EtOH plus palmitoleic acid. Adenoviral ATG4B overexpression in acinar cells greatly reduced LC3-II and inhibited autophagy. Furthermore, it aggravated trypsinogen activation and necrosis, mimicking key responses of ex vivo alcoholic pancreatitis. Conversely, shRNA Atg4B knockdown enhanced autophagosome formation and alleviated ethanol-induced acinar cell damage. The results reveal a novel mechanism, whereby ethanol inhibits autophagosome formation and thus sensitizes pancreatitis, and a key role of ATG4B in ethanol's effects on autophagy. Enhancing pancreatic autophagy, particularly by downregulating ATG4B, could be beneficial in mitigating the severity of alcoholic pancreatitis.NEW & NOTEWORTHY Ethanol sensitizes mice and humans to pancreatitis, but the underlying mechanisms remain obscure. Autophagy is important for maintaining pancreatic acinar cell homeostasis, and its impairment drives pancreatitis. This study reveals a novel mechanism, whereby ethanol inhibits autophagosome formation through upregulating ATG4B, a key cysteine protease. ATG4B upregulation inhibits autophagy in acinar cells and aggravates pathological responses of experimental alcoholic pancreatitis. Enhancing pancreatic autophagy, particularly by down-regulating ATG4B, could be beneficial for treatment of alcoholic pancreatitis.

Patient, hospital and environmental costs of unnecessary bloodwork: capturing the triple bottom line of inappropriate care in general surgery patients

ObjectiveTo characterise the extent of unnecessary care in general surgery inpatients using a triple bottom line approach.DesignPatients with uncomplicated acute surgical conditions were retrospectively evaluated for unnecessary bloodwork according to...

Reliability of Medical Information Provided by ChatGPT: Assessment Against Clinical Guidelines and Patient Information Quality Instrument.

ChatGPT-4 is the latest release of a novel artificial intelligence (AI) chatbot able to answer freely formulated and complex questions. In the near future, ChatGPT could become the new standard for health care professionals and patients to access medical information. However, little is known about the quality of medical information provided by the AI. We aimed to assess the reliability of medical information provided by ChatGPT. Medical information provided by ChatGPT-4 on the 5 hepato-pancreatico-biliary (HPB) conditions with the highest global disease burden was measured with the Ensuring Quality Information for Patients (EQIP) tool. The EQIP tool is used to measure the quality of internet-available information and consists of 36 items that are divided into 3 subsections. In addition, 5 guideline recommendations per analyzed condition were rephrased as questions and input to ChatGPT, and agreement between the guidelines and the AI answer was measured by 2 authors independently. All queries were repeated 3 times to measure the internal consistency of ChatGPT. Five conditions were identified (gallstone disease, pancreatitis, liver cirrhosis, pancreatic cancer, and hepatocellular carcinoma). The median EQIP score across all conditions was 16 (IQR 14.5-18) for the total of 36 items. Divided by subsection, median scores for content, identification, and structure data were 10 (IQR 9.5-12.5), 1 (IQR 1-1), and 4 (IQR 4-5), respectively. Agreement between guideline recommendations and answers provided by ChatGPT was 60% (15/25). Interrater agreement as measured by the Fleiss κ was 0.78 (P<.001), indicating substantial agreement. Internal consistency of the answers provided by ChatGPT was 100%. ChatGPT provides medical information of comparable quality to available static internet information. Although currently of limited quality, large language models could become the future standard for patients and health care professionals to gather medical information.

A case of gallstone pancreatitis due to cholesterol stones in which magnetic resonance cholangiopancreatography was useful

A case of gallstone pancreatitis due to cholesterol stones in which magnetic resonance cholangiopancreatography was useful

The risk of recurrent pancreatitis after first episode of acute pancreatitis in relation to etiology and severity of disease: A systematic review, meta-analysis and meta-regression analysis.

The study aims to determine and quantify the stratified risk of recurrent pancreatitis (RP) after the first episode of acute pancreatitis in relation to etiology and severity of disease. A systematic review and meta-analysis in compliance with PRISMA statement standards was conducted. A search of electronic information sources was conducted to identify all studies investigating the risk of RP after the first episode of acute pancreatitis. Proportion meta-analysis models using random effects were constructed to calculate the weighted summary risks of RP. Meta-regression was performed to evaluate the effect of different variables on the pooled outcomes. Analysis of 57,815 patients from 42 studies showed that the risk of RP after first episode was 19.8% (95% confidence interval [CI] 17.5-22.1%). The risk of RP was 11.9% (10.2-13.5%) after gallstone pancreatitis, 28.7% (23.5-33.9%) after alcohol-induced pancreatitis, 30.3% (15.5-45.0%) after hyperlipidemia-induced pancreatitis, 38.1% (28.9-47.3%) after autoimmune pancreatitis, 15.1% (11.6-18.6%) after idiopathic pancreatitis, 22.0% (16.9-27.1%) after mild pancreatitis, 23.9% (12.9-34.8%) after moderate pancreatitis, 21.6% (14.6-28.7%) after severe pancreatitis, and 6.6% (4.1-9.2%) after cholecystectomy following gallstone pancreatitis. Meta-regression confirmed that the results were not affected by the year of study (P=0.541), sample size (P=0.064), length of follow-up (P=0.348), and age of patients (P=0.138) in the included studies. The risk of RP after the first episode of acute pancreatitis seems to be affected by the etiology of pancreatitis but not the severity of disease. The risks seem to be higher in patients with autoimmune pancreatitis, hyperlipidemia-induced pancreatitis, and alcohol-induced pancreatitis and lower in patients with gallstone pancreatitis and idiopathic pancreatitis.

Management of Anesthesia in Laparoscopic Cholecystectomy During First Trimester Pregnancy

Pregnant women increase the risk of gallbladder disease. Acute cholecystitis occurs 1-6 per 10.000 pregnancy and Cholecystectomy is the second most frequent procedure in pregnancy. Biliary stasis and biliary smooth muscle relaxation due to elevated estrogen and progesterone hormones during pregnancy can lead to gallstones formation. Cholelithiasis complications associated with choledocholithiasis, acute cholecystitis, cholangitis and, gallstone pancreatitis that posing significant morbidity and mortality like spontaneous abortion, preterm labor, and fetal loss. Laparoscopic surgical techniques are no longer a contraindication to non-obstetric surgery for pregnant women although they still have a risk of developing fetal development disorders. Management of anesthesia in laparoscopic cholecystectomy during pregnancy must consider the risk of anesthesia surgery, from the disease, maternal and fetal condition, and manipulation when surgeon performing laparoscopic. This report presenting a 33-years-old woman with 10-week pregnancy who undergoes laparoscopic cholecystectomy followed by symptomatic cholelithiases. It was done with general anesthesia combined with epidural analgesia. After the procedure, there is no complaint about abdominal pain or vaginal bleeding. The patient was discharged 3 days aftercare.