Hospitalization For Acute Pancreatitis Research Articles

8443 Incretin-Mimetic Therapy In Hypertriglyceridemia-Induced Pancreatitis - A Case Report

Abstract Disclosure: A. Iqbal: None. U. Alwahab: None. Introduction The use of incretin-mimetic therapy (IMT), which includes human glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) agonists, in patients with a history of pancreatitis is controversial. While clinical trials have demonstrated a slightly increased incidence of acute pancreatitis (AP) in patients on IMT, it is unclear if patients with hypertriglyceridemia (HTG)-induced pancreatitis areat similar risk. In patients with type 2 diabetes (T2D) and HTG, control of diabetes and improvement of metabolic profile using IMT could decrease the risk of HTG-induced pancreatitis. Case Description We report a case of a patient with diabetes and a history of HTG-induced pancreatitis where IMT was successfully used without precipitation of AP. Patient A is a 44-year-old male with obesity (BMI 38.25 kg/m2 ), T2D, and severe HTG associated with recurrent episodes of AP. His triglyceride (TG) level has ranged from 983 to >4,000 mg/dL. He is on fenofibrate, icosapent ethyl, and rosuvastatin. His last hospitalization for acute pancreatitis was 3months prior. His most recent hemoglobin A1c is 7.4%, TG is 302mg/dL, and he is being treated with glipizide, metformin, empagliflozin, and multiple daily injections of insulin. For management of his obesity and T2D, he is then started on tirzepatide, in conjunction with diet and lifestyle modification, which is slowly up-titrated to 7.5 mg weekly. After 12 months of tirzepatide treatment, he has lost 10 lbs, his A1C is now 5.9%, triglycerides have improved to 172 mg/dL, and he has had no precipitation of AP. Discussion While a history of pancreatitis is a relative contraindication to the use of IMT, attention should be paid to the cause of pancreatitis. Obesity and uncontrolled diabetes are frequent triggers of AP. IMT helps improve metabolic profile in patients with obesity, uncontrolled diabetes, and hypertriglyceridemia, thus decreasing triglyceride levels and preventing further episodes of AP as seen in our patient. The use of IMT in patients with a history of AP should be done on an individualized basis. Controlling the trigger for the AP (such as hypertriglyceridemia) should be prioritized and shared medical decision-making with the patient should be done regarding the benefits and risks of IMT. Presentation: 6/3/2024

S44 One-Year Risk of Opioid Use Disorder After Hospitalization for Acute Pancreatitis

S44 One-Year Risk of Opioid Use Disorder After Hospitalization for Acute Pancreatitis

Trends and Outcomes of US Hypertriglyceridemia-Induced Acute Pancreatitis Hospitalizations in Hispanic Americans: Epidemiology from 2016 to 2020.

Hypertriglyceridemia-induced acute pancreatitis (HTG-AP) hospitalizations are increasing in the USA; however, the impact of race and ethnicity on key outcomes in Hispanic and non-Hispanic white HTG-AP hospitalizations has not been studied. We queried the National Inpatient Sample (NIS) between 2016 and 2020 identifying all patients with discharge diagnosis AP. HTG-AP hospitalizations were identified for Hispanic and non-Hispanic white patients. Primary outcomes included yearly rate of HTG-AP and in-hospital mortality from HTG-AP. Secondary outcomes were length of stay (LOS) and inflation-adjusted hospital costs. HTG-AP hospitalizations accounted for 5.9% of all AP hospitalizations; 17,440 and 48,235 hospitalizations included a Hispanic and non-Hispanic white patient, respectively. The yearly rate of HTG-AP hospitalizations per 100,000 adult population was statistically higher for Hispanics compared to non-Hispanic whites. The HTG-AP hospitalization rate increased for both Hispanics and non-Hispanic whites (both ptrend < 0.001); however, the trends were not statistically different. The number of observed in-hospital deaths for Hispanics was too low to report, precluding subsequent analysis. Hispanics were younger, more likely to be female, more commonly Medicaid recipients, and from zip codes with lower income quartiles. Despite clinically similar rates of plasmapheresis use and LOS, adjusted hospital costs were 18.9% higher for Hispanics compared to non-Hispanic whites (95% CI, 15.4 to 22.6% higher, p < 0.001). HTG-AP incidence is increasing in the USA in Hispanic and non-Hispanic whites. Despite clinically similar outcomes, HTG-AP hospitalizations in Hispanic patients were associated with $26,805,280 in excess costs compared to non-Hispanic white hospitalizations.

New method for surgical treatment of pancreatic head cysts

Aim. To evaluate the clinical efficacy of a new method for drainage of pancreatic head cysts. Materials and methods. The results of treatment of 3 patients with pancreatic head cysts were analyzed in a new way. In all patients, cysts developed against the background of recurrent pancreatitis; the etiology of pancreatitis was alimentary. All cysts were located in the pancreatic head, mainly on its posterior surface, communicating with the ductal system. Results. No intra- and postoperative complications were revealed. Patients were discharged from hospital on the 8–12th day after surgery. In all observations, good results were obtained: no pain syndrome reported; psychological status and food intake normalized. α-amylase in urine and plasma has not increased. No recurrence of cysts and no hospitalizations for acute pancreatitis were reported. Conclusion. The developed method for treating pancreatic head cysts communicating with the ductal system proved to be physiological, low-traumatic and can be used in surgical practice.

Assessment of risk factors in patients undergoing difficult cholecystectomy: a cross-sectional study at a tertiary care hospital in Central India

Background: Laparoscopic cholecystectomy (LC) is the operation of choice in the treatment of symptomatic gallstone disease. Most of the time, the levels of difficulties are hard to assume. The risk factors for difficult LC have not been adequately evaluated in Indian population, especially with respect to western Indian population. Thus, the present study was undertaken to assess the risk factors in patients undergoing difficult cholecystectomy. Method: The study involved 100 adult patients with cholelithiasis admitted in the department of surgery for cholecystectomy over a period of 2 years from Nov 2020 to Dec 2022. Preoperatively, patients were evaluated for risk factors including age, gender, BMI, history of sickle cell disease, previous abdominal surgery, presence of pericholecystic collection, gall bladder thickness, impacted calculi, adhesions in triangle of Calot‘s, and previous hospitalization for acute cholecystitis and acute pancreatitis. These factors were assessed to predict difficult LC. Results: Majority of laparoscopic procedures were easy (65%), while remaining were difficult (35%). Difficult cholecystectomy was significantly associated with age ≥50 years (p=0.016), male gender (p=0.031), BMI ≥25 kg/m2 (p&lt;0.0001), sickle cell disease (p=0.030), previous abdominal surgery (p=0.004), pericholecystic collection (p=0.017), gall bladder thickness ≥4 mm (p=0.007), adhesion in triangle of Calot‘s (p&lt;0.0001), impacted calculi (p=0.036), previous hospitalization for acute cholecystitis and acute pancreatitis (p&lt;0.0001) and diabetes mellitus (p&lt;0.0001). The conversion rate was 2%. Conclusions: An awareness about reliable predictors for difficult LC would be helpful for an appropriate treatment plan and application of the resources to anticipate difficult LC. However, further studies with larger sample size are required to confirm the findings.

S78 Is Aspirin Use Associated With Decreased Incidence, Better Outcomes, and Decreased Cost of Acute Pancreatitis Hospitalizations?

S78 Is Aspirin Use Associated With Decreased Incidence, Better Outcomes, and Decreased Cost of Acute Pancreatitis Hospitalizations?

S89 Outcomes of Acute Pancreatitis Hospitalization in Patients With Inflammatory Bowel Disease: A Nationwide Analysis

S89 Outcomes of Acute Pancreatitis Hospitalization in Patients With Inflammatory Bowel Disease: A Nationwide Analysis

The Influence of Obesity on Acute Pancreatitis Hospitalizations: Does Body Mass Index Matter?

To identify the influence of body mass index (BMI) on Acute Pancreatitis (AP) hospitalizations in the United States (US). The National Inpatient Sample was utilized to identify normal weight, overweight and obese AP hospitalizations in the US from 2016-2019 based on BMI. Hospitalization characteristics and outcomes were compared. Between 2016-2019, there were 314,215 (74.7%) obese, 27,005 (6.4%) overweight and 79,380 (18.9%) normal weight AP hospitalizations. Obese AP hospitalizations were younger (51.5 vs 56.5 years, p < 0.0001) compared to the normal weight cohort. However, normal weight AP hospitalizations had a higher proportion of Blacks and Asians compared to the obese subgroup. We also noted a higher all-cause inpatient mortality for normal weight AP hospitalizations (3.4% vs 2.8% vs 1.8%, p < 0.0001) compared to the overweight and obese cohorts, respectively. Furthermore, normal weight AP hospitalizations had a higher proportion of patients with pancreatic pseudocyst formation and pancreatic necrosis compared to the overweight and obese cohorts. The mean length of stay (5.8 vs 8.2 days, p < 0.0001) and mean total healthcare costs ($66,742 vs $82,319, p < 0.0001) were lower for obese compared to normal weight AP hospitalizations. Normal weight AP hospitalizations had higher inpatient mortality and complications compared to obese hospitalizations.

Vliv pandemie covidu-19 na akutní pankreatitidu v České republice – pilotní data studie PANACOTA (PANcreatitis Acuta in COvid Time Analysis)

Summary: Introduction: The COVID-19 pandemic had a significant impact on health care. Previous studies point to a possible negative impact of COVID-19 infection on the development and severity of acute pancreatitis. The aim of this study is to analyze the impact of the COVID-19 pandemic on the epidemiology, treatment and prognosis of acute pancreatitis at the population level. Methods: Using data from the National Registry of Reimbursed Health Services (NRRHS) parameters of hospital admissions for acute pancreatitis, the provided health care and treatment outcomes in the pandemic period (2020 and 2021) with previous years (2010–2019) were compared. Results: The incidence during the pandemic was not significantly different from the previous period: 67 vs. 63 per 100,000 population. Hospitalizations for acute pancreatitis in each month of 2020 and 2021 did not correlate with the number of COVID-19 positive patients. The overall mortality rates for acute pancreatitis before and during the pandemic were almost identical – at 3.8% and 3.9%, respectively. There was a trend towards a decrease in the number of surgical procedures, a gradual decrease in ERCPs and an increase in endoscopic drainages throughout the 2010–2021 period. The crude mortality rate of patients hospitalized for COVID-19 and concomitant acute pancreatitis was 14.2% and these patients were operated in 4.7%. Conclusions: Based on pilot population data, the COVID-19 pandemic did not have an impact on the incidence of acute pancreatitis in the Czech Republic. A more severe course and prognosis of the disease was associated with near-term COVID-19 positivity. More frequent indication of surgical and other interventions for acute pancreatitis in COVID-19 positive individuals may have been related to the disruption of standard quality and availability of care. Key words: acute pancreatitis – COVID-19 – epidemiology – endoscopic drainage – surgery – complications

Number of recurrences is significantly associated with the post-acute pancreatitis diabetes mellitus in a population with hypertriglyceridemic acute pancreatitis

BackgroundTwenty-three percent of patients are diagnosed with diabetes mellitus after the first episode of acute pancreatitis. The incidence of post-acute pancreatitis diabetes mellitus is significantly higher than that of type 1 diabetes mellitus. Some studies have concluded that the all-cause mortality and worse prognosis of diabetes after pancreatitis are higher. We predicted that number of recurrences of pancreatitis would be significantly associated with the incidences of metabolic syndrome, abdominal obesity, and post-acute pancreatitis diabetes mellitus.MethodsPatients admitted to our hospital for hypertriglyceridemic acute pancreatitis from 2013–2021 were selected for a cross-sectional study. Statistical analysis methods were used to analyze the effect of recurrences on the long-term prognosis of patients with hypertriglyceridemic acute pancreatitis.ResultsIn this study, 101 patients with hypertriglyceridemic acute pancreatitis were included: 60 (59.41%) in the recurrent acute pancreatitis group and 41 (40.59%) in the only one episode of acute pancreatitis group. Among all hypertriglyceridemic acute pancreatitis patients, approximately 61.4% were diagnosed with abdominal obesity, 33.7% of patients are diagnosed with metabolic syndrome, 34.7% of patients are diagnosed with diabetes mellitus, and 21.8% of patients are diagnosed with post-acute pancreatitis diabetes mellitus. Recurrent acute pancreatitis were independent risk factors for post-acute pancreatitis diabetes mellitus in patients with hypertriglyceridemic acute pancreatitis (odds ratio [OR] = 3.964, 95% confidence interval [CI] = 1.230–12.774) and the risk of post-acute pancreatitis diabetes mellitus in patients with three or more recurrent episodes was 6.607 times higher than that in patients without recurrent episodes (OR = 6.607, 95% CI = 1.412–30.916).ConclusionsRecurrence is an independent risk factor for the development of post-acute pancreatitis diabetes mellitus and is significantly associated with the number of recurrences.

Lipid metabolism for predicting the recurrence of hypertriglyceridemic acute pancreatitis

Rationale and objectivesTo investigate the predictive value of lipid metabolism in predicting the recurrence of hypertriglyceridemic acute pancreatitis (HTG-AP). Materials and methodsA total of 892 patients were admitted to our hospital for acute pancreatitis (AP) from January 2017 to December 2020, of whom 198 diagnosed with HTG-AP were enrolled in this retrospective study. Demographic information, length of stay, smoking index, alcohol abuse, necrosis, severity, baseline lipid metabolism and other blood biochemical indicators were recorded. The risk factors of recurrence were evaluated using univariate and multivariate Cox proportional risk analyses, and the cumulative recurrence-free survival rate of patients were calculated using Kaplan Meier method and the differences between groups were compared using the log-rank test. ResultsUnivariate and multivariate analysis showed that triglyceride (hazard ratio, 2.421; 95% CI, 1.152–5.076; P = 0.020), non high-density lipoprotein (hazard ratio, 4.630; 95% CI, 1.692–12.658; P = 0.003) and apolipoprotein A1 (hazard ratio, 1.735; 95% CI, 1.093–2.754; P = 0.019) were important predictors for recurrence of HTG-AP. Subsequently, patients were divided into four groups according to the cut off values of triglyceride, non high-density lipoprotein and apolipoprotein A1. It was found that the cumulative recurrence-free survival rate of patients in highest-risk group or high-risk group was significantly lower than that of medium-risk group (P < 0.001, P = 0.003) or low risk group (P < 0.001). ConclusionSerum triglycerides, non high-density lipoprotein and apolipoprotein A1 are independent predictors of recurrence in HTG-AP patients, which can provide reference for individualized treatment and prevention of recurrence in HTG-AP patients.

Predicting Hospitalization, Organ Dysfunction, and Mortality in Post-Endoscopic Retrograde Cholangiopancreatography Acute Pancreatitis: Are SIRS and qSOFA Reliable Tools?

Background: Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) has shown constant incidence throughout time, despite advances in endoscopic technology, devices, or personal skills of the operating endoscopists, with prevention and prediction of severity in PEP being constant concerns. Several prospective studies have investigated the role of systemic inflammatory response syndrome (SIRS) criteria or the quick Sequential Organ Failure Assessment (qSOFA) score in the PEP severity assessment. However, there are no clearly defined tools for the prediction of PEP severity. Methods: A total of 403 patients were prospectively monitored 60 days after ERCP for the detection of PEP development. Consequently, we evaluated the lengths of stay, incidence of organic dysfunction, and mortality rates of these patients. The predictive power of the univariate model was evaluated by using the receiver operating characteristic curve and analyzing the area under the curve (AUC). Results: Incidence of PEP was similar to that reported in the majority of trials. The 60-day survival rate of PEP patients reached 82.8%. A qSOFA score ≥ 1 is a very good predictor for organ dysfunction (AUC 0.993, p &lt; 0.0001). SIRS can also be considered a significant predictor for organic dysfunctions in PEP patients (AUC 0.926, p &lt; 0.0001). However, only qSOFA was found to significantly predict mortality in PEP patients (AUC 0.885, p = 0.003), with SIRS criteria showing a much lower predictive power. Neither SIRS nor qSOFA showed any predictive value for the length of stay of PEP patients. Conclusion: Our study offers novel information about severity prediction in PEP patients. Both SIRS criteria and qSOFA showed good predictive value for organic dysfunction, mortality, and hospitalization.

Relationship of the systemic immuno-inflammation index and hematological inflammatory index with mortality and hospitalization in acute pancreatitis: a cross-sectional study

Objective: This study was conducted to reveal the relationship of the hematological inflammatory index (HII) and systemic immuno-inflammation index (SII) with short-term and prolonged hospitalization in cases of acute pancreatitis.&#x0D; Methods: This single-center cross-sectional study was conducted in the emergency department (ED) of an educational hospital. The study population contained cases who untaken to the ED with acute pancreatitis between August 15, 2021, and May 15, 2022. Cases discharged from the ED, those referred to another center for hospitalization, and those with absent information were excluded from the study. The patients were grouped according to the length of hospital stay (expected and prolonged) and short-term mortality (survivor and died). We constructed a receiver operating characteristic (ROC) curve for short-term mortality and prolonged hospitalization and obtained the area under the curve (AUC) values for SII and HII.&#x0D; Results: One hundred seventy-seven patients were included in the study. There was no significant difference between the expected and prolonged hospitalization groups in the terms of SII and HII (P=0.649 and P=0.084, respectively). There was also no significant difference between the survivor and died groups in the terms of these indexes (P=0.070 for HII and P=0.138 for SII). The AUC values for the SII and HII in the prediction of 30-day mortality were 0.616 and 0.642, respectively. The AUC values for the SII and HII in the prediction of prolonged hospitalization were 0.580 and 0.642, respectively.&#x0D; Conclusion: The outcomes of the present study showed no significant difference among the expected and prolonged hospitalization groups or the survivor and died groups in the terms of SII and HII. We recommend the validation of our results in multicenter studies with larger samples.

The relationship between systemic immune-inflammation index and length of hospitalization in acute pancreatitis

The relationship between systemic immune-inflammation index and length of hospitalization in acute pancreatitis

Evinacumab in severe hypertriglyceridemia with or without lipoprotein lipase pathway mutations: a phase 2 randomized trial

Severe hypertriglyceridemia (sHTG) is an established risk factor for acute pancreatitis. Current therapeutic approaches for sHTG are often insufficient to reduce triglycerides and prevent acute pancreatitis. This phase 2 trial (NCT03452228) evaluated evinacumab (angiopoietin-like 3 inhibitor) in three cohorts of patients with sHTG: cohort 1, familial chylomicronemia syndrome with bi-allelic loss-of-function lipoprotein lipase (LPL) pathway mutations (n = 17); cohort 2, multifactorial chylomicronemia syndrome with heterozygous loss-of-function LPL pathway mutations (n = 15); and cohort 3, multifactorial chylomicronemia syndrome without LPL pathway mutations (n = 19). Fifty-one patients (males, n = 27; females, n = 24) with a history of hospitalization for acute pancreatitis were randomized 2:1 to intravenous evinacumab 15 mg kg−1 or placebo every 4 weeks over a 12-week double-blind treatment period, followed by a 12-week single-blind treatment period. The primary end point was the mean percent reduction in triglycerides from baseline after 12 weeks of evinacumab exposure in cohort 3. Evinacumab reduced triglycerides in cohort 3 by a mean (s.e.m.) of −27.1% (37.4) (95% confidence interval −71.2 to 84.6), but the prespecified primary end point was not met. No notable differences in adverse events between evinacumab and placebo treatment groups were seen during the double-blind treatment period. Although the primary end point of a reduction in triglycerides did not meet the prespecified significance level, the observed safety and changes in lipid and lipoprotein levels support the further evaluation of evinacumab in larger trials of patients with sHTG. Trial registration number: ClinicalTrials.gov NCT03452228.

Prospective evaluation of an emergency department protocol to prevent hospitalization in mild acute pancreatitis: Outcomes and predictors of discharge

BackgroundWhile acute pancreatitis (AP) contributes significantly to hospitalizations and costs, most cases are mild with minimal complications. In 2016, we piloted an observation pathway in the emergency department (ED) for mild AP and showed reduced admissions and length of stay (LOS) without increased readmissions or mortality. After 5 years of implementation, we evaluated outcomes of the ED pathway and identified predictors of successful discharge. MethodsWe reviewed a prospectively enrolled cohort of patients with mild AP presenting to a tertiary care center ED between 10/2016 and 9/2021, evaluating LOS, charges, imaging, and 30-day readmission, and assessed predictors of successful ED discharge. Patients were divided into two main groups: successfully discharged via the ED pathway (“ED cohort”) and admitted to the hospital (“admission cohort”), with subgroups to compare outcomes, and multivariate analysis to determine predictors of discharge. ResultsOf 619 AP patients, 419 had mild AP (109 ED cohort, 310 admission cohort). The ED cohort was younger (age 49.3 vs 56.3,p < 0.001), had lower Charlson Comorbidity Index (CCI) (1.30 vs 2.43, p < 0.001), shorter LOS (12.3 h vs 116 h, p < 0.001), lower charges (mean $6768 vs $19886, p < 0.001) and less imaging, without differences in 30-day readmissions. Increasing age (OR: 0.97; p < 0.001), increasing CCI (OR: 0.75; p < 0.001) and biliary AP (OR: 0.10; p < 0.001) were associated with decreased ED discharge, while idiopathic AP had increased ED discharge (OR: 7.8; p < 0.001). ConclusionsAfter appropriate triage, patients with mild AP (age <50, CCI <2, idiopathic AP) can safely discharge from the ED with improved outcomes and cost savings.

S53 Disparities in the Readmission Rates After Hospitalization for Acute Pancreatitis

Introduction: Acute pancreatitis (AP) is one of the leading causes of hospitalization in the United States. Patients with AP frequently get readmitted and that proves to be a great burden on our healthcare system. Age, male sex, tobacco use, alcohol use, and necrotizing pancreatitis have been linked to a higher readmission rate in AP patients. However, studies on the impact of socioeconomic status are lacking. Our study attempts to find the impact of income on the readmission rates in patients admitted for AP. Methods: We queried the National Readmission Database (NRD) from 2017 to 2018 to identify patients with a primary diagnosis of AP. Those who died during the index hospitalization were excluded when examining readmission rates. Multivariable Cox proportional-hazards regression was used to study the impact of income on 90-day readmission adjusted for age, sex, comorbidities, hospital characteristics, and primary payer. Results: A total of 313,565 AP patients were identified, 99,023 of whom belonged to median income quartile 1, 89,582 to quartile 2, 74,027 to quartile 3, and 50,933 to quartile 4 with quartile 4 having the highest income. Slightly more than half of each quartile group were men (53.1%, 52.8%, 53.0%, 53.5%, respectively). Patients with lower income had higher prevalence of comorbidities. Among those who survived the index hospitalization, 21,694 (21.9%), 18,880 (21.1%), 15,264 (20.6%), and 9,854 (19.3%) patients in quartiles 1, 2, 3, and 4 were readmitted within 90 days, respectively. When compared with the highest income quartile (quartile 4), patients in quartiles 1, 2, and 3 were associated with an increasingly higher hazard of readmission (quartile 1, aHR 1.09, p< 0.001; quartile 2, aHR 1.07, p< 0.001; quartile 3, aHR 1.06, p< 0.001). (Figure) Conclusion: Our study finds a positive correlation between poverty and the 90-day readmission rate in AP patients. Alcohol use is one of the top causes of pancreatitis in the US. It would be interesting to investigate if there is a difference in the prevalence of substance use in patients of various economic strata that could be impacting the readmission. Furthermore, it is imperative that we bring reforms in our financial and health policy to make it more equiTable in order to alleviate some of the disparities we see.Figure 1.: Kaplan-Meier curves of readmissions after acute pancreatitis stratified to median income quartile

S1838 Spontaneous Gastro-pancreatic Fistula: A Rare Complication of Acute Pancreatitis

Introduction: Although Gastrointestinal fistula is a well-recognized complication of acute pancreatitis, it has been rarely reported. Here we present a rare case of spontaneous gastro-pancreatic fistula following acute pancreatitis. Case Description/Methods: 42 y/o female with PMH of SLE with a recent prolonged hospitalization for acute drug-induced pancreatitis with pseudocyst came to ED with fever, abdominal pain, nausea, and vomiting. She was tachycardic, had leukocytosis, and was positive for COVID-19. CT Scan A/P showed multiple infected peripancreatic collections with communication of the left upper quadrant collection with the gastric lumen (Figure). The patient was hospitalized, Kept NPO, and started on fluids and antibiotics. IR evaluated and put 2 pigtail catheters for drainage of peripancreatic collections. The tip of the pigtail catheter in the left peripancreatic/retroperitoneal collection was in the gastric lumen. The surgery team recommended continuing with conservative treatment with parenteral nutrition, and IV antibiotics as the patient were nontoxic with no signs of free perforation, and pancreatitis would more likely erode a staple or suture line and would put the patient at further risk of free perforation if repair attempted. IR was successful in pulling the drain out of the gastric lumen on the second attempt to allow gastric perforation to heal. Antibiotics were upgraded as per the culture and sensitivity results of the drain fluid. Repeated multiple bedside leak tests and CT scans with oral contrast continue to be positive for patent gastro-pancreatic fistula. Pigtails catheter continues to drain significant necrotic collection. The patient continues to be hospitalized and is being managed conservatively with Parenteral nutrition, and IV antibiotics. Discussion: Fistula of the GI tract following acute pancreatitis can be caused by multiple reasons. Necrosis of the bowel may occur concomitantly with the pancreatic or peripancreatic tissue. Furthermore, enzyme-rich fluid and necrosis can lead to vascular thrombosis, which compromises the blood supply of the segmental GI tract, eventually leading to bowel necrosis. GI fistulas are more common in patients with necrotizing pancreatitis with infected pancreatic necrosis. Despite pharmacologic suppression of pancreatic exocrine secretion and advances in endoscopic and percutaneous therapeutic techniques, pancreatic fistula continues to be a source of morbidity and mortality following pancreatitis and requires multidisciplinary treatment.Figure 1.: Peripherally enhancing fluid collection in the left upper quadrant/gastric wall. There is a communication between this collection with the gastric lumen.

S38 Impact of Diabetes Mellitus on Acute Pancreatitis Outcomes in a Large Prospective Observational Cohort

Introduction: Acute pancreatitis (AP) is a leading indication for hospital admission. The relationship between AP and diabetes mellitus (DM) is becoming increasingly recognized. Many patients with DM have comorbid conditions (ex. heart and renal disease) that may increase the risk of severe pancreatitis or pancreatitis outcomes. We aim to identify the impact of DM on acute pancreatitis hospital outcomes including organ failure, readmission, and death. Methods: We identified patients hospitalized for acute pancreatitis between January 2015 and March 2021 using our prospective observational cohort. We included patients who had an episode of acute pancreatitis with or without pre-existing DM. Outcomes of interest included severity of pancreatitis, necessity of an intensive care unit (ICU) stay, organ failure, readmission, and death. Information on demographics, medical history, biochemical data, severity of the pancreatitis episode (Revised Atlanta Classification), and imaging were obtained for analysis. Logistic regression was used for analysis. Results: A total of 1340 unique patients were included in the analysis. 313 (23.4%) of the patients had pre-existing DM while 1027 (76.6%) did not. The overall cohort was 46.8% female and 81.3% Hispanic. The mean age in the patients with pre-existing DM was 53 ( ± 14) years old, while the non-diabetic cohort was 43 (± 15) years old. Patients with diabetes mellitus were significantly more likely to have moderate-to-severe pancreatitis [OR 1.52 (1.11-2.09)]. With regards to hospital outcomes, the diabetes cohort were more likely to have an intensive care unit (ICU) stay [2.26 (1.65-3.11)], and necessity of ICU interventions such as vasopressors [5.06 (2.25-11.38)], intubation [2.21 (1.13-4.35)], and renal replacement therapy (RRT) [4.77 (1.92-11.88)]. No significant difference was seen in readmission within 30 days [0.79 (0.51-1.23)] but patients with diabetes were more likely to have hospitalization result in death [3.49 (1.41-8.60)]. Conclusion: Within our acute pancreatitis population, patients with diabetes mellitus were more likely to have both local and systemic complications as well as necessity of more invasive hospital interventions such as intubation and vasopressors compared to their non-diabetic counterparts. These results emphasize the importance of adequately controlling patients’ underlying diabetes to minimize risk of hospital complications (Table). Table 1. - Comparison of hospitalization outcomes for acute pancreatitis in diabetics vs. non-diabetics No Diabetesn=1027, (76.6%) Diabetesn=313, (23.4%) P value OR (95% CI) Pancreatitis Severity Mild 857 (83.4%) 238 (76.0%) 0.003 Mod/Severe 170 (16.6%) 75 (24.0%) 0.003 1.52 (1.11-2.09) Organ Failure (any) 104 (10.1%) 54 (17.3%) 0.001 1.69 (1.16-2.44) Respiratory Failure 81 (7.9%) 34 (10.9%) 0.100 Circulatory Failure 20 (2.0%) 15 (4.8%) 0.006 Renal Failure 37 (3.6%) 33 (10.5%) < 0.0001 ICU Stay (yes/no) 138 (13.4%) 82 (26.2%) < 0.0001 2.26 (1.65-3.11) ICU LOHS (days) 0.8 1.5 0.031 Intubation 23 (2.2%) 16 (5.1%) 0.008 2.21 (1.13-4.35) Vasopressors 11 (1.1%) 17 (5.4%) < 0.0001 5.06 (2.25-11.38) RRT 9 (0.9%) 12 (3.8%) < 0.0001 4.77 (1.92-11.88) Readmission within 30 days 116 (11.3%) 29 (9.3%) 0.312 0.79 (0.51-1.23) Death 10 (1.0%) 12 (3.8%) < 0.0001 3.49 (1.41-8.60) Footnote: -OR=odds ratio, from multivariate analysis controlling for age, gender, and comorbidities such as heart failure, chronic kidney disease, and cirrhosis. ICU= intensive care unit; RRT = renal replacement therapy.

Pain Control Disparities in Acute Pancreatitis.

Background and objectivePatient treatments and outcomes have historically differed based on age, sex, race/ethnicity, and social factors, and there is a growing awareness that such disparities still exist. While prior studies have found that patients belonging to minority groups have their pain undertreated, few studies have evaluated pain control based on age, sex, body mass index (BMI), or presence of a substance use disorder (SUD). The studies that do exist have inconsistent results. This study aimed to evaluate pain control in patients admitted to a Denver academic safety net hospital for acute pancreatitis. Pancreatitis is an inherently painful condition involving pancreatic inflammation and for which adequate pain control is a cornerstone of treatment; this makes it an ideal disease state for an exploratory analysis into the experience of pain within different patient groups.MethodsThis was a retrospective cohort study of patients treated at the Denver Health Medical Center from January 1, 2017, through December 31, 2019, for acute pancreatitis; 659 patients met the inclusion criteria and were included in the study. Pain control during the first 24 hours of hospital admission was analyzed by comparing controlled vs. uncontrolled reports of pain and mean pain scores. Patients were stratified by age, sex, self-reported race/ethnicity, BMI, and presence of SUD at the time of admission. Achievement of "controlled pain," as defined by a pain score below the patient’s stated functional pain goal, was then analyzed. Chi-squared analysis was employed to look into differences within and between groups. Additionally, a t-test was used to compare mean pain scores between groups with controlled and uncontrolled pain.ResultsA statistically significant difference in pain control was found when stratified by age or the presence of SUD (p<0.001). Within these groups, 39% of those aged 18-40 years achieved pain control, compared with 49% of those aged 41-64 years and 66% of those aged 65 years and older. Among those with active SUD, only 41% were able to achieve pain control compared with 58% of those without SUD. Among those who achieved pain control, the average mean pain score was 5, which decreased to 4 within 24 hours. Among those who did not achieve pain control, the average mean pain score was 7, which remained at 7 at 24 hours (p<0.001).ConclusionsWe did not find significant differences in the ability to achieve tolerable pain control based on sex or BMI. We were unable to appropriately analyze differences based on race/ethnicity due to an inability to differentiate between White Hispanic and White non-Hispanic populations within Epic. However, we did find significantly poorer pain control in younger patients and those with an active SUD.