Hospitalization For Pancreatitis Research Articles

FRI101 Marked Reduction In Severe Resistant Hypertriglyceridemia On PCSK9 Inhibitor

Abstract Disclosure: S. Kaul: None. A. Gupta: None. Introduction: PCKS9 inhibitors, such as evolocumab, have been shown to lower triglyceride levels by approximately 10-20% (1). However, there have not been any reports of PCSK9 inhibitors lowering triglyceride levels by more than 100%. Clinical Case: A 35-year-old white man presented with hypertriglyceridemia for more than eight years. Past medical history was significant for recurrent pancreatitis and diabetes mellitus type 2 with recent HbA1c of 7.6% (normal range <5.7%) on metformin 1 gram BID and insulin glargine 15 units daily. He had multiple hospitalizations for pancreatitis requiring insulin drip. His triglycerides remained elevated on fenofibrate, atorvastatin, and icosapent ethyl despite alcohol avoidance and changes in diet with progressive elevation to 5000 mg/dL (normal range 0-150 mg/dL) requiring four sessions of plasmapheresis and hospitalization requiring intravenous insulin drip. His family history also included hypertriglyceridemia in his mother. He was started on evolocumab 140 mg subcutaneously every 2 weeks and noted to have drastic improvement of triglycerides down to a normal level of 138 mg/dL. On recent labs, his triglyceride level was noted to be 921 mg/dL with HbA1c at 8.0%. He did admit non-compliance to diet but did not require any more hospitalizations for pancreatitis since starting evolocumab. Conclusions: This is the first reported case of an unexplored potential of evolocumab in patients with severe hypertriglyceridemia. Reference: (1) Warden BA, Fazio S, Shapiro MD. The PCSK9 revolution: Current status, controversies, and future directions. Trends Cardiovasc Med. 2020;30(3):179-185. doi:10.1016/j.tcm.2019.05.007 Presentation: Friday, June 16, 2023

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?

S123 A Nationwide Population-Based Study of Racial Differences in the Outcomes of Necrotizing Pancreatitis Hospitalizations

S123 A Nationwide Population-Based Study of Racial Differences in the Outcomes of Necrotizing 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.

National Trends in Interventions for Pediatric Gallstone Pancreatitis.

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

Temporal Analysis of Inflammatory Bowel Disease and Pancreatitis Co-Occurrence in Children and Adults in the United States.

Pancreatitis in inflammatory bowel disease has been attributed to peripancreatic intestinal disease and/or drug-induced pancreatic toxicity. We used large cohort analyses to define inflammatory bowel disease and pancreatitis temporal co-occurrence with a detailed descriptive analysis to gain greater insight into the pathophysiological relationship between these 2 diseases. Truven Health MarketScan private insurance claims from 141,017,841 patients (younger than 65 years) and 7,457,709 patients from 4 academic hospitals were analyzed. We calculated the prevalence of Crohn's disease or ulcerative colitis (UC) with acute pancreatitis or chronic pancreatitis (CP) and performed temporal and descriptive analyses. Of 516,724 patients with inflammatory bowel disease, 12,109 individuals (2.3%) had pancreatitis. Acute pancreatitis (AP) was 2-6x more prevalent than CP. In adults, AP occurred equally among Crohn's disease and UC (1.8%-2.2% vs 1.6%-2.1%, respectively), whereas in children, AP was more frequent in UC (2.3%-3.4% vs 1.5%-1.8%, respectively). The highest proportion of pancreatitis (21.7%-44.7%) was at/near the time of inflammatory bowel disease diagnosis. Of them, 22.1%-39.3% were on steroids during pancreatitis. Individuals with CP or recurrent pancreatitis hospitalizations had increased risk of a future inflammatory bowel disease diagnosis (odds ratio = 1.52 or 1.72, respectively). Pancreatitis in inflammatory bowel disease may not simply be a drug adverse event but may also involve local and/or systemic processes that negatively affect the pancreas. Our analysis of pancreatitis before, during, and after inflammatory bowel disease diagnosis suggests a bidirectional pathophysiologic relationship between inflammatory bowel disease and pancreatitis, with potentially more complexity than previously appreciated.

Effect of surgical timing on outcomes after cholecystectomy for mild gallstone pancreatitis

BackgroundRetrospective and single-center studies have demonstrated that early cholecystectomy is associated with shorter length of stay in patients with mild gallstone pancreatitis. However, these studies are not powered to detect differences in adverse events. Using a nationally representative cohort, we evaluated the association of timing for cholecystectomy with clinical outcomes and resource use in patients with gallstone pancreatitis. MethodsAll adult hospitalizations for gallstone pancreatitis were tabulated from the 2016–2019 Nationwide Readmissions Database. Using International Classification of Disease, 10th Revision codes, patient comorbidities and operative characteristics were determined. Patients with end-organ dysfunction or cholangitis were excluded to isolate those with only mild gallstone pancreatitis. Major adverse events were defined as a composite of 30-day mortality and perioperative (cardiovascular, respiratory, neurologic, infectious, and thromboembolic) complications. Timing of laparoscopic cholecystectomy was divided into Early (within 2 days of admission) and Late (>2 days after admission) cohorts. Multivariable logistic and linear regression were then used to evaluate the association of cholecystectomy timing with major adverse events and secondary outcomes of interest, including postoperative hospital duration of stay, costs, non-home discharge, and readmission rate within 30 days of discharge. ResultsOf an estimated 129,451 admissions for acute gallstone pancreatitis, 25.6% comprised the Early cohort. Compared to patients in the Early cohort, Late cohort patients were older (56 [40–69] vs 53 [37–66] years, P < .001), more likely male (36.6 vs 32.8%, P < .001), and more frequently underwent preoperative endoscopic retrograde cholangiopancreatography (22.2 vs 10.9%, P < .001). In addition, the Late cohort had higher unadjusted rates of major adverse events and index hospitalization costs, compared to Early. After risk adjustment, late cholecystectomy was associated with higher odds of major adverse events (adjusted odds ratio 1.40, 95% confidence interval 1.29–1.51) and overall adjusted hospitalization costs by $2,700 (95% confidence interval 2,400–2,800). In addition, compared to the Early group, those in the Late cohort had increased odds of 30-day readmission (adjusted odds ratio 1.12, 95% confidence interval 1.03–1.23) and non-home discharge (adjusted odds ratio 1.42, 95% confidence interval 1.31–1.55). ConclusionCholecystectomy >2 days after admission for mild gallstone pancreatitis was independently associated with increased major adverse events, costs, 30-day readmissions, and non-home discharge. Given the significant clinical and financial consequences, reduced timing to surgery should be prioritized in the overall management of this patient population.

Imaging of Pancreatitis, Panniculitis, and Polyarthritis Syndrome

HomeRadiologyVol. 307, No. 4 PreviousNext Reviews and CommentaryFree AccessImages in RadiologyImaging of Pancreatitis, Panniculitis, and Polyarthritis SyndromeLakhdeep Singh Brar , Yatin ChadhaLakhdeep Singh Brar , Yatin ChadhaAuthor AffiliationsFrom the Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, ON, Canada N6A 3K7 (L.S.B.); and Department of Medical Imaging, North York General Hospital, Toronto, Canada (Y.C.).Address correspondence to L.S.B. (email: [email protected]).Lakhdeep Singh Brar Yatin ChadhaPublished Online:May 2 2023https://doi.org/10.1148/radiol.222426MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In A 64-year-old man initially presented with pancreatitis that required hospitalization. Several months later, he developed knee pain and a fluctuant soft tissue mass at the lateral aspect of the left knee. Rheumatologic and metabolic workups (serum calcium and phosphate, and parathyroid hormone) were negative. Radiography performed 10 months after the initial onset of pancreatitis (Figure, A) showed bilateral symmetric osteopenia involving the knees with a permeative appearance of the bones. Subsequent bilateral knee MRI scans (Figure, B and C) demonstrated bilateral multifocal osteonecrosis with rim enhancement in the soft tissues of the left knee, supporting panniculitis. Subsequent imaging showed improvement of all imaging findings. The patient was referred to orthopedic oncology at a tertiary care center as a precaution. The diagnosis of pancreatitis, panniculitis, and polyarthritis (PPP) syndrome was made based on the clinical and imaging findings.Images in a 64-year-old man presenting with knee pain 10 months after hospitalization for pancreatitis. (A) Anteroposterior radiograph of both knees shows a permeative appearance of the bones (arrows). (B) Coronal T1-weighted knee MRI scan shows osteonecrosis. (C) Coronal T1-weighted postgadolinium MRI scan shows bilateral multifocal osteonecrosis (arrowheads) and panniculitis (rim enhancing) in the lateral soft tissues of the left knee (arrow).Download as PowerPointOpen in Image Viewer PPP syndrome is rare and occurs in the setting of pancreatitis or an underlying pancreatic mass (1). Patients may report mild or absent abdominal symptoms, making it difficult to diagnose. It has been reported to occur in all age groups, with a mean age ± SD of 51 years ± 16, and has a higher prevalence rate in men than in women (2:1 ratio) (2). While any joint may be involved, it most commonly affects the knees, ankles, and wrists (2). The pathophysiology is thought to result from the release of pancreatic lipase into the circulation, causing lipolysis and inflammation (2). The clinical symptoms and imaging findings can be transient or persist over time (3). Treatment involves addressing the underlying pancreatitis (3).Disclosures of conflicts of interest: L.S.B. No relevant relationships. Y.C. No relevant relationships.

National trends and clinical outcomes of interventional approaches following admission for infected necrotizing pancreatitis in the United States.

With recent studies demonstrating the efficacy of minimally invasive approaches following infected necrotizing pancreatitis, latest guideline recommendations support their use. However, large-scale studies are lacking, and the national landscape following these guidelines remains poorly characterized. The present study examined trends in intervention strategies and the association of approach on clinical outcomes and resource use in a nationally representative cohort. The 2016-2019 National Inpatient Sample was queried for adult hospitalizations for pancreatitis with infected necrosis. Patients were classified as drain only (DO) if they received only percutaneous or endoscopic drainage, minimally invasive (MIS) if they underwent endoscopic or laparoscopic debridement, and Open if they underwent open debridement. The primary outcome was in-hospital mortality, while secondary outcomes included perioperative complications, home discharge, and resource use. Multivariable regression models were developed to evaluate the association of intervention with clinical and financial endpoints. Of 4,605 patients who received interventions, 1,735 (37.6%) were DO, 1,490 (32.4%) were MIS, and 1,380 (30.0%) were considered Open. The proportion of DO and MIS increased, while Open declined (2016, 47.0%; 2019, 24.6%; p < 0.001). Compared with Open, MIS had lower rates of abdominal compartment syndrome while having greater rates of preoperative closed drainage (31.9% vs. 13.8%, p < 0.001). After adjustment, odds of in-hospital mortality, respiratory failure, prolonged ventilation, and acute kidney injury were significantly higher in the Open cohort compared with MIS. Hospitalization duration was longer ( β , +12.1 days; 95% confidence interval, 6.8-17.5), and costs were higher ( β , +$58.7K; 95% confidence interval, 33.5-83.9) in Open compared with MIS. Minimally invasive approaches for infected pancreatic necrosis have increased over time, while open necrosectomy has declined. Open approaches compared with drainage only or minimally invasive debridement were associated with greater odds of numerous in-hospital complications and resource burden. Prognostic and Epidemiological; Level IV.

P541 Diagnosis, management, and evolution of acute pancreatitis secondary to thiopurines in patients with Inflammatory Bowel Disease: an ENEIDA registry study.

Abstract Background Treatment with thiopurines in patients with Inflammatory Bowel Disease (IBD) may be associated with different adverse effects, including acute pancreatitis. Our aims were to evaluate the clinical presentation, severity and management of acute pancreatitis related to thiopurines in patients with IBD. Methods IBD patients with acute pancreatitis secondary to treatment with thiopurines for IBD were identified from the prospectively maintained ENEIDA registry of the Spanish Working Group on Crohn’s Disease and Ulcerative Colitis (GETECCU). We included those patients who met the Atlanta diagnostic criteria and had an imaging test that ruled out biliary origin of pancreatitis. Investigators at each participating centre provided additional information on pancreatitis clinical evolution and management. Results We included 290 patients with pancreatitis in 34 centres; 54% were women, 84% had Crohn’s disease and 56% were smokers. Five (1.7%) had had pancreatitis before, but no patient met criteria for chronic pancreatitis. The median age at pancreatitis was 36 years (IQR 27-50). In 94% of cases, pancreatitis occurred after the first thiopurine drug. Azathioprine was the thiopurine used in 97% of cases (median dose 2.3 mg/kg/day (IQR 2-2.5)), and 6% were treated with mercaptopurine (1.5 mg/kg/day (IQR 1-1.5)). Pancreatitis was diagnosed after a median of 23 days (IQR 14-35) since the start of the treatment with thiopurines. 81% required hospitalization for pancreatitis for a median of 5 days (IQR 4-7). Four (1.4%) were severe pancreatitis, 16 (5.5%) moderate, and the rest mild, according to the Atlanta classification. No epidemiological or treatment factors were associated with the severity of pancreatitis. Thiopurine was withdrawn in all patients upon diagnosis of pancreatitis. After 2 months (IQR 1-28) of pancreatitis, 16 patients (5.5%) received thiopurines again (5 the same, 11 a different thiopurine), suffering a new episode of pancreatitis in 12 (75%) after a median of 12 days (IQR 5-34). Pancreatitis occurred in all smokers that were treated again with thiopurines (n=7), compared to 5 of the 9 (56%) non-smokers or former smokers (p=0.04, RR 1.8; 95% CI 1.1-3.2). Conclusion Acute pancreatitis secondary to treatment with thiopurines is mild in most patients, usually appearing during the first month of treatment. The reintroduction of thiopurines, although feasible in some cases, is not recommended due to the high risk of developing a new pancreatitis, especially in smokers.

S1741 Gelatinous Ascites and a Double Duct Sign: A Case of Pancreatic Adenocarcinoma

Introduction: Pseudomyxoma peritonei (PMP) is a rare disorder characterized by the accumulation of gelatinous material within the abdomen and pelvis. While usually appendiceal in origin, it can be seen with mucinous tumors arising from the ovary, GI tract, urachus, and pancreas. We describe a case of pancreatic adenocarcinoma diagnosed due to the clinical syndrome precipitated by pseudomyxoma peritonei. Case Description/Methods: A 59-year-old Hispanic male presented to the hospital for evaluation due to a 2 month history of poor oral intake and worsening abdominal fullness, distension, discomfort, and intermittent pain. The patient reported one prior hospitalization for pancreatitis of unclear etiology, 3 years ago. A CT abdomen & pelvis was obtained; findings reported include multiple hepatic subcapsular cystic liver lesions, abdominal omental caking, ascites, and extrahepatic biliary and pancreatic ductal dilatation without definitive evidence of a mass. CEA and CA 19-9 were found to be elevated at 49.4 and 416 respectively. CT chest revealed a left-sided pleural effusion. Upper endoscopy and colonoscopy were negative. Paracentesis yielded gelatinous ascites. Clinical suspicion for appendiceal malignancy was raised which required surgical exploration and biopsy to confirm. An MRI of the abdomen was obtained to assess for pancreatic mass given presence of double duct sign. MRI revealed 2.2 x 2.7 x 5 cm lesion in the body of the pancreas, pseudomyxoma peritonei with scalloping of the liver and extension into the right posterior mediastinum via the esophageal hiatus, metastatic deposits in the porta hepatis and peritoneal carcinomatosis. No apparent abnormality in the appendix was observed. EUS FNA was performed; splenic vessel invasion by the mass was noted. Cytopathology supported a diagnosis of pancreatic adenocarcinoma. The patient was initiated on palliative chemotherapy with gemcitabine and nab-paclitaxel which led to a significant reduction in ascites and pleural effusion and improvement in symptoms. Discussion: This case highlights the potential of malignancies such as pancreatic adenocarcinoma to cause pseudomyxoma peritonei despite it more commonly being associated with appendiceal origin. Knowledge of this can help guide diagnostic and therapeutic plans.

Eruptive Xanthomas

Eruptive Xanthomas

Continuing Medical Education Questions: December 2021.

Article Title: Cystic Fibrosis Transmembrane Conductance Regulator Modulator Use is Associated with Reduced Pancreatitis Hospitalizations in Subjects with Cystic Fibrosis.

Cystic Fibrosis Transmembrane Conductance Regulator Modulator Use Is Associated With Reduced Pancreatitis Hospitalizations in Patients With Cystic Fibrosis.

Acute pancreatitis (AP) occurs among patients with pancreas-sufficient cystic fibrosis (PS-CF) but is reportedly less common among patients with pancreas-insufficient cystic fibrosis (PI-CF). The incidence of AP may be influenced by cystic fibrosis transmembrane conductance regulator (CFTR) modulator use. We hypothesized that CFTR modulators would reduce AP hospitalizations, with the greatest benefit in PS-CF. MarketScan (2012-2018) was queried for AP hospitalizations and CFTR modulator use among patients with CF. Multivariable Poisson models that enabled crossover between CFTR modulator treatment groups were used to analyze the rate of AP hospitalizations on and off therapy. Pancreas insufficiency was defined by the use of pancreas enzyme replacement therapy. A total of 10,417 patients with CF were identified, including 1,795 who received a CFTR modulator. AP was more common in PS-CF than PI-CF (2.9% vs 0.9%, P = 0.007). Overall, the observed rate ratio of AP during CFTR modulator use was 0.33 (95% confidence interval [CI] 0.10, 1.11, P = 0.07) for PS-CF and 0.38 (95% CI 0.16, 0.89, P = 0.03) for PI-CF, indicating a 67% and 62% relative reduction in AP hospitalizations, respectively. In a subset analysis of 1,795 patients who all had some CFTR modulator use, the rate ratio of AP during CFTR modulator use was 0.36 (95% CI 0.13, 1.01, P = 0.05) for PS-CF and 0.53 (95% CI 0.18, 1.58, P = 0.26) for PI-CF. CFTR modulator use is associated with a reduction in AP hospitalizations among patients with CF. These observational data support the prospective study of CFTR modulators to reduce AP hospitalizations among patients with CF.

Pathophysiology and Biomarker Potential of Fatty Acid Ethyl Ester Elevation During Alcoholic Pancreatitis

The role of fatty acid ethyl esters (FAEEs) during human alcoholic pancreatitis is unknown. We compared FAEEs levels with their nonesterified fatty acids (NEFAs) precursors during alcohol intoxication and clinical alcoholic pancreatitis. The pathophysiology underlying FAEEs increase and their role as diagnostic biomarkers for alcoholic pancreatitis was investigated. A prospective blinded study compared FAEEs, NEFAs, and ethanol blood levels on hospitalization for alcoholic pancreatitis (n= 31), alcohol intoxication (n= 25), and in normal controls (n= 43). Serum FAEEs were measured at admission for nonalcoholic pancreatitis (n= 75). Mechanistic cell and animal studies were done. Median FAEEs were similarly elevated during alcohol intoxication (205 nmol/L; 95% confidence interval [CI], 71.8-515 nmol/L, P < .001) and alcoholic pancreatitis (103.1 nmol/L; 95% CI, 53-689 nmol/L, P < .001) vs controls (1.7 nmol/L; 95% CI, 0.02-4.3 nmol/L) or nonalcoholic pancreatitis (8 nmol/L; 95% CI, 1.1-11.5 nmol/L). Alcoholic pancreatitis increased serum NEFAs (1024 ± 710 μmol/L vs 307 ± 185 μmol/L in controls, P < .05). FAEEs comprised 0.1% to 2% of the parent NEFA concentrations. FAEES correlated strongly with NEFAs independent of ethanol levels in alcoholic pancreatitis but not during alcohol intoxication. On receiver operating characteristic curve analysis for diagnosing alcoholic pancreatitis, the area under the curve for serum FAEEs was 0.87 (95% CI, 0.78-0.95, P < .001). In mice and cells, alcohol administration transiently increased all FAEEs. Oleic acid ethyl ester was the only FAEE with a sustained increase up to 24 hours after intraperitoneal oleic acid plus ethanol administration. The sustained, alcohol-independent, large (20- to 50-fold) increase in circulating FAEEs during alcoholic pancreatitis results from their visceral release and mirrors the 2- to 4-fold increase in parent NEFA. The large areas under the curve of FAEEs on receiver operating characteristic curve analysis supports their role as alcoholic pancreatitis biomarkers.

Effect of ambient temperature on daily hospital admissions for acute pancreatitis in Nanchang, China: A time-series analysis

ABSTRACT The aim of this study was to evaluate the short-term effect of temperature on the risk of acute pancreatitis (AP) in southern China. We performed a time-series study of 2822 patients admitted with a first episode of AP in Nanchang between May 2014 and June 2017. A generalized additive model combined with a distributed lag non-linear model was applied to assess the association of temperature and AP. In subgroup analysis, according to different etiologies of pancreatitis, significant associations were found between daily average temperature and non-biliary pancreatitis hospitalization at lags of 0–7 days, but not for biliary pancreatitis or total AP. Higher daily average temperature tended to increase the occurrence of non-biliary pancreatitis at lags of 0–7 days. These findings suggest that high temperature is associated with higher non-biliary pancreatitis risk in Nanchang, China. In the context of global warming, the morbidity of non-biliary pancreatitis may increase.

Early Versus Late Laparoscopic Cholecystectomy in Patients with Acute Gallstone Pancreatitis

The laparoscopic cholecystectomy is the definite treatment of acute gallstone pancreatitis, but the timing remains controversial. We aimed to evaluate trends, prevalence, and outcomes of laparoscopic cholecystectomy amongst patients with acute gallstone pancreatitis in index hospitalization done at different time intervals. We performed a retrospective study using Nationwide Inpatient Sample (years 2003–2014) with adult hospitalizations with acute gallstone pancreatitis who underwent laparoscopic cholecystectomy using ICD-9-CM codes and divided them into subgroups of those who underwent immediately (72 h), early (1 week), and delayed (> 1 week) laparoscopic cholecystectomy. The weighted analysis using chi-square, paired Wilcoxon-rank-sum test, Cochran-Armitage trend test, and multivariable survey logistic regression analysis was performed to evaluate prevalence and outcomes. There was a total of 582,406 acute gallstone pancreatitis admissions of which 291,701 (50.09%) patients had laparoscopic cholecystectomy (p < 0.0001). Prevalence of immediate laparoscopic cholecystectomy 114,629 (40.55%) showed incremental trend (32.61 to 49.82%) compared to early 149,931 (53.03%) (57.83 to 46.59%), and late laparoscopic cholecystectomy 18,158 (6.42%) (9.56 to 3.59%) from 2003 to 2014. Immediate and early laparoscopic cholecystectomy had lower prevalence and odds of mortality [0.24% versus 0.37% versus 2.46%; aOR-immediate: 0.614; aOR-early: 0.615; p < 0.0001], morbidity [1.36% versus 3.64% versus 27.57%; aOR-immediate: 0.088; aOR-early:0.161; p < 0.0001], disability [62.47% versus 70.15% versus 84.26%; aOR-immediate: 0.584; aOR-early: 0.68; p < 0.0001], discharge to non-home [7.07% versus 13.04% versus 31.84%; %; aOR-immediate: 0.346; aOR-early: 0.473; p < 0.0001], hospital cost $39,466 versus $52,018 versus $129,317 (p < 0.0001) and stay 3 days versus 6 days versus 19 days (p < 0.0001) than delayed laparoscopic cholecystectomy. The immediate laparoscopic cholecystectomy showed better outcomes; more prospective studies with large numbers of patients should be planned to evaluate the beneficial effects of immediate cholecystectomy in severe acute pancreatitis hospitalizations.

Hypertriglyceridemia-Induced Pancreatitis: A 3-Year Retrospective Cohort Study on Clinical Severity and Recurrence Rates

Introduction: Hypertriglyceridemia is a well-recognized cause for acute pancreatitis, however, there is a paucity of information regarding triglyceride (TAG) levels and its impact on disease course. We aimed to identify all hypertriglyceridemia-induced pancreatitis (HTGP) from 2016 to 2019 and to evaluate the impact of TAG levels on disease severity and recurrence rates. Methods: 1457 admissions for pancreatitis were screened and 15 patients with HTGP were found. Information regarding recurrence rates, disease severity, length of stay, management, and mortality were extracted and compared against TAG levels. Results: TAG levels on initial presentation ranged from 5 to 131mmol/L (mean 40mmol/L). There was no relation between TAG levels on initial presentation and recurrence rates. Recurrent pancreatitis occurred in 60% of this cohort (n=9). Frequency of recurrence (>2 episodes per year) was associated with persistently high TAG levels ranging from 10 to 50mmol/L. Those who had recurrent episodes with TAG levels ranging from 6 to 10mmol/L either had poor glycaemic control or a history of alcoholism. Based on the Atlanta criteria, 30% experienced severe pancreatitis (n=5). TAG levels ranged from 10 to 113mmol/L during these severe episodes (median 37mmol/L; mean 53mmol/L). Mean duration of hospitalization for severe pancreatitis was 4 weeks (range: 1-15 weeks). No deaths were directly associated with these episodes of acute pancreatitis. Conclusion: High TAG levels correlate with greater recurrence rates and severe pancreatitis. Poor glycaemic control and alcohol intake also contribute to these outcomes. Early diagnosis and management of HTGP is integral in preventing recurrence and improving long-term outcomes.

Case report: xanthogranulomatous cholangitis mimicking cholangiocarcinoma

Presenter: Jenny Q Zhang MD | Rhode Island Hospital Background: Xanthogranulomatous cholangitis is an extremely rare diagnosis and is believed to be an extension of xanthogranulomatous cholecystitis, a benign inflammatory process characterized by lipid-laden macrophages. Here, we report a case of isolated xanthogranulomatous cholangitis mimicking cholangiocarcinoma. Methods: A 72-year-old male who was previously admitted to the hospital for gallstone pancreatitis, cholangitis s/p ERCP with plastic stent placement, and Klebsiella bacteremia underwent interval laparoscopic cholecystectomy with liver biopsy. His pathology revealed chronic cholecystitis and no fibrosis, steatosis or inflammation in the liver biopsy. Postoperatively, he continued to endorse night sweats, unintentional weight loss, and jaundice. He underwent ERCP with exchange of the common bile duct stent multiple times with no alleviation of symptoms. Liver function tests remained mildly elevated (Tbili 1.3, AST 78, ALT 64, Alk Phos 673). CEA was normal (1.1) but CA19-9 was significantly elevated at 160. CT abdomen/pelvis showed new intrahepatic duct dilation and portal vein thrombus. ERCP with SpyGlass revealed right hepatic system underfilling, narrowing of the right intrahepatic duct takeoff, and abnormal biliary tract mucosa characterized by nodularity, scarring, purulence, and decreased vascularity. Cytology of the right main hepatic duct showed atypical cells. Given the constellation of findings, there was high clinical suspicion of early intrahepatic cholangiocarcinoma and he was consented for liver resection. Results: The patient subsequently underwent right hepatectomy and portal lymphadenectomy. Pathology showed xanthogranulomatous cholangitis of large hepatic bile ducts, bile granuloma, hepatic parenchyma with features of large bile duct obstruction, chronic cholestasis, and biliary pattern of fibrosis with bridging septa. Dedicated stains for bacteria and fungi were negative, and there was no evidence of malignancy. He tolerated the procedure well and was discharged home with services on postoperative day 4. Conclusion: We present a patient with initial workup concerning for intrahepatic cholangiocarcinoma. Final pathology showed xanthogranulomatous cholangitis with no malignancy. Interestingly, he did not have xanthogranulomatous cholecystitis. Xanthogranulomatous cholangitis is a very rare phenomenon that can lead to benign strictures of the bile ducts, especially in the setting of recurrent cholangitis.