Mild Pancreatitis Research Articles

Early evaluation of waist-to-height ratio for the prediction of worsening acute pancreatitis.

The purpose of this study was to evaluate the association between the waist-to-height ratio (WHtR) and the aggravation of acute pancreatitis (AP). This prospective study included AP patients treated from May 2019 to December 2019 in the Department of Gastroenterology, the First Affiliated Hospital of Nanchang University. Receiver operating characteristic curves were constructed to determine the optimal threshold values for predicting the aggravation of AP. Risk factor analysis was performed via logistic regression analysis. Of 258 patients included in this study, 77 (29.84%) were diagnosed with mild acute pancreatitis, 120 (46.51%) with moderately severe acute pancreatitis, and 61 (23.64%) with severe acute pancreatitis (SAP). WHtR, waist circumference, weight, and body mass index were all associated with AP severity, and the highest area under the receiver operating characteristic value was observed for WHtR. The optimal threshold WHtR value for predicting SAP was 0.567. Multivariate logistic regression analysis identified WHtR ≥ 0.567 as independent risk factor for SAP. Moreover, the hospital stay was longer and intensive care unit admission rate was higher among AP patients with a WHtR ≥ 0.567. The WHtR was found to be closely related to the severity of AP and an independent risk factor for the aggravation of AP. This simple parameter can aid the early prediction of AP progression, thereby facilitating early intervention and improving patient outcomes.

External application of mirabilite before surgery can reduce the inflammatory response and accelerate recovery in mild acute biliary pancreatitis

ObjectiveMild acute biliary pancreatitis (MABP) is one of the most common diseases that require surgical treatment. Previous studies have focused on the timing of laparoscopic cholecystectomy (LC) for MABP. However, the impact of its inflammatory response process on the clinical outcome has been rarely reported. This study aimed to investigate the effect of preoperative external application of mirabilite on the inflammatory response and clinical efficacy in MABP.MethodsMedical records of patients undergoing LC due to MABP from November 2017 to June 2022 were retrospectively reviewed. Prior to surgery, the control group received the same baseline treatment measures as the study group. The difference was the addition of external application of mirabilite in the study group.ResultsA total of 75 patients were included in the final analysis: 38 patients in the mirabilite group and 37 patients in the control group. Repeated-measures ANOVA (P < 0.01) showed that the white blood cell count (WBC) on the 3rd day of admission and the WBC and C-reactive protein (CRP) level on the 5th day of admission decreased rapidly and significantly in the mirabilite group, compared with the control group. The mirabilite group had earlier anal exhaust time. The number of patients in the mirabilite group and control group with gallbladder wall ≥ 3 mm before the operation was 16 (42.11%) vs. 24 (64.86%), p = 0.048, respectively; and the number of cases with surgical drain placement was 2 (5.26%) vs. 9 (24.32%), p = 0.020, respectively. The intraoperative modified American Fertility Society (mAFS) score of adhesions was lower in the mirabilite group (1.08 ± 0.59 points) than in the control group (1.92 ± 0.60 points), p = 0.000. The mirabilite group, compared to the control group, p = 0.000, had a short waiting time for surgery (5.68 ± 0.70 days vs. 6.54 ± 0.59 days), short operation time (38.03 ± 5.90 min vs. 48.51 ± 8.37 min), and reduced hospitalization time (8.95 ± 0.96 days vs. 9.84 ± 1.07 days).ConclusionThis study demonstrated that preoperative external application of mirabilite can reduce the inflammatory response, decrease the edema and peribiliary adhesions at the surgical site, and accelerate recovery in MABP.

COMPARITIVE STUDY OF PANC-3 AND BEDSIDE INDEX FOR SEVERITY IN ACUTE PANCREATITIS (BISAP) SCORING SYSTEM TO IDENTIFY SEVERITY OF PANCREATITIS

Background &amp; Objectives: Objective of this study is to evaluate accuracy and predictability of PANC-3 over BISAP scoring system to predict severity in an attack of acute pancreatitis. Methods: A total of 160 cases were enrolled in the study and was conducted in Department of General Surgery, ESICMC &amp; PGIMSR, Bangalore. All patients with clinical diagnosis of acute pancreatitis will be included in the study. It was a prospective study with study period of 18 months. Results: A total number of 160 patients were included in the study. Patients presenting with acute pancreatitis were maximum in age group of 31-40 years which included 60 patients (37.5). 153 (96%) patients were male and 4 percent (n=7) are female. Most common cause is alcohol- 124 (77.5%) patients. Next common cause is the gallstone 19 patients (11.9%). The most common chief complaint in our study was characteristic upper abdominal pain (100%) followed by vomiting (22.5%), fever (13.8%), jaundice (1.9%) and abdominal distension (1.3%). 91 patients were diagnosed to have mild acute pancreatitis, 37 patients with moderate acute pancreatitis and 32 patients with severe acute pancreatitis. All the 32 patients were correctly predicted by PANC-3 score. 11(6.9%) developed complications like pancreatic necrosis, pancreatic abscess, upper gastrointestinal bleeding, MODS, sepsis and death. 3 patients died due to complications associated with severe pancreatitis which accounts for 1.9%. Interpretation &amp;Conclusion: Our study shows that PANC-3 can be used to predict the severity of pancreatitis as efficiently as BISAP scoring. It uses only 3 criteria which are easily done and available in even the basic health care setup. The interpretation of PANC-3 does not need expertise and can be applied at the time of admission which is an advantage when compared to classical scoring systems.

Association between time in range 70-180 mg/dl in early stage and severity with in patients acute pancreatitis

BackgroundIt is not well understood whether glucose control in the early stage of acute pancreatitis(AP) is related to outcome. This study aimed to investigate the association between blood glucose time in range (TIR) of 70–180 mg/dL in the first 72 h(h) on admission and the progression of AP.MethodsIndividuals admitted with AP to the Gastroenterology Department of the Affiliated Changzhou No.2 People’s Hospital of Nanjing Medical University between January 2017 and December 2021 were included and retrospectively evaluated. The percentage of TIR between 70 and 180 mg/dL in the first 72 h was calculated. According to the progress of AP at discharge, patients were divided into mild pancreatitis(MAP), and moderately severe acute pancreatitis (MSAP), or severe acute pancreatitis (SAP) groups. We examined the association between TIR or TIR ≥ 70% and AP severity using logistic regression models stratified by a glycosylated hemoglobin (HbA1c) level of 6.5%. Receiver operating characteristic (ROC) curves were generated to assess the ability of the TIR to predict MSAP or SAP.ResultsA total of 298 individuals were included, of whom 35 developed MSAP or SAP. Logistic regression analyses indicated that TIR was independently associated with the incidence of more serious AP (odds ratio [OR] = 0.962, 95% CI = 0.941–0.983, p = 0.001). This association remained significant in individuals with HbA1c levels ≤ 6.5% (OR = 0.928, 95% CI = 0.888–0.969, p = 0.001). A TIR ≥ 70% was independently associated with reduced severity only in people with well-antecedent controls (OR = 0.238; 95% CI = 0.071–0.802; p = 0.020). TIR was not powerful enough to predict the severity of AP in both patients with poor antecedent glucose control (AUC = 0.641) or with HbA1c < 6.5% (AUC = 0.668).ConclusionsTIR was independently associated with severity in patients with AP, particularly those with good antecedent glucose control.

Nano-curcumin supplementation in patients with mild and moderate acute pancreatitis: A randomized, placebo-controlled trial.

We aimed to investigate whether nano-curcumin as an anti-inflammatory agent is effective in patients with mild and moderate AP. This study was a double-blind, parallel-arm randomized controlled trial conducted at Taleghani hospital, Tehran, Iran. Eligible subjects with a diagnosis of mild and moderate AP were randomly assigned to receive either two doses of nano-curcumin (40 mg) or placebo (control) daily for 2 weeks. The primary endpoint was gastrointestinal (GI) ward length of stay (LOS). A total of 42 patients were randomly assigned to receive either nano-curcumin (n = 21) or placebo (n = 21). Compared with placebo, nano-curcumin supplementation decreased hospital LOS (RR = 0.67, 95% CI: 0.502-0.894; p = 0.006), reduced the need for analgesics over time (OR = 0.576, 95% CI: 0.421-0.790; p = 0.001), and increased overall appetite score over the study period (β = 0.104, SE: 0.053; p = 0.049). No adverse effects or mortality were reported and there was no withdrawal during the study period. The results indicate that nano-curcumin as an adjuvant therapy is safe and may reduce GI ward LOS, analgesics requirement, and improve the overall appetite in patients with mild and moderate AP. Future multi-center trials with larger sample sizes are required to verify these findings. Clinical trial registration: www.ClinicalTrials.gov NCT04989166.

The 2023 MANCTRA Acute Biliary Pancreatitis Care Bundle: A Joint Effort Between Human Knowledge and Artificial Intelligence (ChatGPT) to Optimize the Care of Patients With Acute Biliary Pancreatitis in Western Countries.

To generate an up-to-date bundle to manage acute biliary pancreatitis using an evidence-based, artificial intelligence (AI)-assisted GRADE method. A care bundle is a set of core elements of care that are distilled from the most solid evidence-based practice guidelines and recommendations. The research questions were addressed in this bundle following the PICO criteria. The working group summarized the effects of interventions with the strength of recommendation and quality of evidence applying the GRADE methodology. ChatGPT AI system was used to independently assess the quality of evidence of each element in the bundle, together with the strength of the recommendations. The 7 elements of the bundle discourage antibiotic prophylaxis in patients with acute biliary pancreatitis, support the use of a full-solid diet in patients with mild to moderately severe acute biliary pancreatitis, and recommend early enteral nutrition in patients unable to feed by mouth. The bundle states that endoscopic retrograde cholangiopancreatography should be performed within the first 48 to 72 hours of hospital admission in patients with cholangitis. Early laparoscopic cholecystectomy should be performed in patients with mild acute biliary pancreatitis. When operative intervention is needed for necrotizing pancreatitis, this should start with the endoscopic step-up approach. We have developed a new care bundle with 7 key elements for managing patients with acute biliary pancreatitis. This new bundle, whose scientific strength has been increased thanks to the alliance between human knowledge and AI from the new ChatGPT software, should be introduced to emergency departments, wards, and intensive care units.

Exploring the value of early laboratory indicators combined with pancreatitis activity scoring system in assessing the severity and prognosis of acute pancreatitis.

To investigate the value of early laboratory indicators combined with the pancreatitis activity scoring system in assessing the severity and prognosis of acute pancreatitis (AP). This is a retrospective study. A total of 160 patients with AP admitted to the Affiliated Hospital of Hebei University from February 2021 to February 2023 were enrolled and classified into three categories: mild acute pancreatitis (MAP), moderate severe acute pancreatitis (MSAP), and severe acute pancreatitis (SAP), with 80 cases with MAP and MSAP as the control group and 80 cases with SAP as the experimental group. The differences of inflammatory markers, blood routine, biochemical markers, coagulation markers and PASS score within 24 hours after admission were compared between the two groups, and independent risk factors for predicting AP severity were analyzed. Moreover, the diagnostic efficacy and prognostic value of independent risk factors were evaluated. The PASS score as well as CRP, PCT, IL-6, WBC, N, AST, DD and PT were higher in the experimental group than in the control group. Logistic regression analysis suggested that PASS, IL-6, PCT and WBC were independent risk factors for predicting severity of AP. In addition, PASS had the highest diagnostic efficacy. Early elevation of PASS, IL-6, PCT and WBC in patients suffering from AP is of great significance in predicting SAP. PASS score combined with IL-6, PCT and WBC has important value in evaluating the severity and prognosis of AP.

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.

Clinical Utility of Definitive Diagnostic Tests for Choledocholithiasis in Pediatric Patients with Mild Gallstone Pancreatitis

BackgroundGallstone pancreatitis was historically considered a risk factor for choledocholithiasis (CD). However, recent studies of adult patients evidenced a weak association between gallstone pancreatitis and CD. The aim of this study was to analyze this association in pediatric patients. MethodsWe conducted a retrospective study on patients with mild gallstone pancreatitis who underwent any definitive testing for CD (MRCP, ERCP, IOC), managed between March 2010 and September 2022. Patients were classified according to the presence or absence of risk factors for CD (total bilirubin ≥2 mg/dl; common bile duct >6 mm on ultrasound; and/or CD on ultrasound). We evaluated the diagnosis of CD on definitive testing in both groups and analyzed the predictive capacity of the presence of risk factors. ResultsEighty-four patients were included in the final analysis. Seventy-nine percent were females. The median age was 13 (4–17) years. Forty-seven (55.9%) patients had one or more risk factors. The definitive testing confirmed 13 (15.5%) cases of CD, 12 (25.5%) in the group of patients with risk factors and 1 (2.7%) in those without risk factors. The sensitivity, specificity, positive predictive value and negative predictive value of the presence of associated risk factors were 92.3, 50.7, 25.5 and 97.3%, respectively. ConclusionPediatric patients with gallstone pancreatitis without associated risk factors have a very low incidence of CD. In these patients we suggest performing a laparoscopic cholecystectomy without intraoperative cholangiography or any other definitive test for CD. Level of EvidenceLevel II, retrospective study.

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.

Investigation of Serum Human Epididymitis Protein 4 Level in Rats with Experimental Acute Pancreatitis.

We aimed to show whether the serum level of Human Epididymitis Protein 4 increases in rats with an experimental acute pancreatitis model created by cerulein. This study included 24 male Sprague-Dawley rats which were randomly divided into 4 groups each containing 6 rats. the group treated with saline, Group 1: pancreatitis group created with cerulein at a total dose of 80 µg/kg, Group 2: pancreatitis group created with cerulein at a total dose of 120 µg/kg, Group 3: pancreatitis group created with cerulein at a total dose of 160 µg/kg. There were statistically significant differences between edema, acinar necrosis, fat necrosis, and perivascular inflammation scores among the study groups. While the degree of all histopathological findings is lowest in the control group, pancreatic parenchyma damage increases as the amount of injected cerulein increases. There was no statistically significant difference between alanine aminotransferase, aspartate aminotransferase, and Human Epididymis Protein 4 values between study groups. On the other hand, there was a statistically significant difference between amylase and lipase values. The lipase value of the control group was significantly lower than the lipase value of the second and third groups. The amylase value of the control group was significantly lower than all other groups. The highest Human Epididymis Protein 4 value was measured as 104 pmol/L in the first pancreatitis group, where the severity of pancreatitis was mild. In the present study, it was concluded that the Human Epididymis Protein 4 value increased in the case of mild pancreatitis, but there is no correlation between the severity of pancreatitis and the Human Epididymis Protein 4 value.

A COMPARATIVE STUDY BETWEEN APACHE II AND RANSON’S SCORING SYSTEMS IN PREDICTING THE SEVERITY OF ACUTE PANCREATITIS

Aims and Objectives: The aims and objectives of the study are to compare the Ranson’s scoring system with APACHE II score in predicting the severity of acute pancreatitis. Methods: 50 cases having acute pancreatitis were included in this study on the basis of a predefined inclusion and exclusion criteria. Institutional ethical committee was approved the study. The duration of study was 2 years. Informed consent was obtained from the patients. Assessment of severity of pancreatitis was done on the basis of Ranson’s scoring as well as APACHE II score. Final severity score of the patients on the basis of both the scoring systems was assessed to determine the efficacy of each scoring system in predicting the severity. Results: Out of these 50 cases, there were 37 (74%) males and 13 (26%) females. The mean age of affected cases was found to be 36.86±7.91 years. The most common etiological factor was chronic alcoholism which was seen in 22 (44%) patients followed by biliary tract disease or stones (24%), hypertriglyceridemia (14%), post ERCP (2%), idiopathic (14%), and autoimmune pancreatitis (2%). Mild and severe pancreatitis was seen in 35 (70%) and 15 (30%), respectively. APACHE II score was found to be having more sensitivity and positive predictive value for the diagnosis of severe pancreatitis as compared to Ranson’s score. There was no significant difference in specificity, negative predictive value, and accuracy as determined by Ranson’s and APACHE II Score. Conclusion: APACHE II score is better in predicting severity of acute pancreatitis as it is found to have a better sensitivity and positive predictive value for the diagnosis of severe pancreatitis as compared to Ranson’s score.

Course of Acute Pancreatitis Patients with Renal Failure According to Balthazar Classification.

There are criteria that include many organ systems to predict the prognosis in acute pancreatitis (AP) patients. In this study, we aimed to show how the course of the disease changes according to the Balthazar classification in AP patients presenting with renal failure. Our study included 352 patients who were admitted to the Emergency Service of our hospital and were diagnosed and hospitalized with AP. According to the Balthazar score, patients with scores of 0-2, 4-6, and 8-10 were evaluated as mild, moderate, and severe AP, respectively. Demographic data (age, gender) of all patients were documented. The etiology of AP was determined in all patients. Biliary, drug/toxic, alcohol, infections, hyperlipidemia, post-endoscopic retrograde cholangiopancreatography (ERCP), genetics, hypercalcemia, structural anomalies, and malignancy were evaluated as the etiology. Those without any underlying pathology were evaluated as idiopathic AP. The patients were divided into two groups as those with and without renal insufficiency. All patients underwent helical computed tomography (section 64, Aquilion; Toshiba Medical Systems, Tokyo) within the first 12 hours and between days 3 and 7. Pancreas, peripancreatic and extrapancreatic findings, and complications were examined. "The Statistical Package for the Social Sciences 19.0 (SPSS Armonk, NY: IBM Corp.)" was used for all analyses. Kolmogorov-Smirnov test and histograms were used to determine whether there was a normal distribution. The non-parametric data of the groups were compared using the Mann-Whitney U test and the parametric data using the ındependent t test. Chi-square test was used to test categorical data. Cases with P < 0.05 were considered statistically significant. : While 22 (6.2%) patients had renal insufficiency, 332 (95.8%) patients did not have renal insufficiency. In the evaluation made in terms of AP severity; according to Balthazar classification at admission, there was no difference in mild and moderate pancreatitis for kidney insufficiency in both groups, but it was significantly higher in the group with severe pancreatitis [2 (9.1%) versus 1 (0.3%), P < 0.001]. In the evaluation made after 72 hours; renal failure was significantly lower in the group with mild pancreatitis [11 (50.0%) versus 245 (73.8%), P: 0.016] and severe renal failure was significantly higher in severe pancreatitis [7 (31.8%) versus 13 (%) 3.9), P < 0.001]. Early intensive care unit admission and close follow-up and early treatment in AP patients change the course of the disease. In our study, we showed that serum creatinine level is an important parameter in the course of AP and has a predictive value for the course of the disease.

Home care/outpatient versus hospital admission in mild acute pancreatitis: protocol of a multicentre, randomised controlled trial (PADI_2 trial)

IntroductionAcute pancreatitis (AP) is the third most common gastrointestinal disease resulting in hospital admission, with over 70% of AP admissions being mild cases. In the USA, it costs 2.5 billion...

Characterization of Duodenal Microbiota in Patients with Acute Pancreatitis and Healthy Controls

ObjectiveThe small intestinal bacterial overgrowth (SIBO) in acute pancreatitis correlates with the severity of the disease. However, corresponding studies on the microbial composition of the duodenal mucosa of patients are uncommon.MethodsDuodenal mucosal biopsies were collected by gastroscopy from 16 patients with mild acute pancreatitis (the Ap group) and 16 healthy individuals (the control group) and subjected to histological studies as well as bacterial 16S rRNA gene sequencing. Caerulein and l-arginine were used to induce mild acute pancreatitis (MAP) and severe acute pancreatitis (SAP) in mice, respectively, and their pancreas and duodenum were collected for histological studies.ResultsH&E analysis displayed no significant pathological damage in the descending duodenum of patients with acute pancreatitis compared with that of the controls. Immunofluorescence and Real-time PCR revealed that the expressions of tight junction proteins (TJPs) in duodenal mucosa were decreased in acute pancreatitis. The results of the alpha diversity analysis revealed no significant difference between the two groups, while LEfSe and the random forest revealed a few differences, indicating that the descending duodenum mucosal microbiota changed slightly in patients with mild acute pancreatitis. We observed the pathological changes and the expression of TJPs in the duodenum in the three groups of mice and found that SAP mice had more severe pathological damage in the duodenum. Furthermore, the expression of TJPs in the duodenum was lower in the MAP and SAP groups of mice compared to control mice, but it was similar in both groups.ConclusionPatients with mild acute pancreatitis had mild duodenal barrier dysfunction and slight changes in duodenal mucosal microbiota.

Immediate feeding tolerance in patients with mild acute biliary pancreatitis

Immediate feeding tolerance in patients with mild acute biliary pancreatitis

Clinical characteristics and risk factors for tigecycline-induced pancreatitis in a tertiary hospital: a retrospective study.

To analyze the clinical characteristics and risk factors for tigecycline-induced pancreatitis (TIP) and evaluate the safety and efficiency of tigecycline use in non-TIP. A retrospective case-control study was conducted on adult and juvenile patients administered tigecycline for >3 days. The adults were classified as TIP, non-TIP (pancreatitis with other causes), and non-pancreatitis. Univariate analyses were performed to compare TIP and non-pancreatitis, and multivariate analysis was used to identify risk factors for TIP. The clinical characteristics of TIP and the safety and efficiency of tigecycline use in non-TIP were evaluated. A total of 3910 patients (3823 adults and 87 juveniles) were enrolled. The adult patients comprised 21 TIP, 82 non-TIP, and 3720 non-pancreatitis. The TIP prevalences were 0.56% in adults and 1.15% in juveniles. The mean time from tigecycline use to symptom onset was 7.2 days, and all cases were mild pancreatitis. The mean time from tigecycline withdrawal to symptom relief was 3.6 days. The multivariate analysis identified comorbid renal insufficiency as an independent risk factor for TIP (odds ratio = 3.032). Among the 82 non-TIP patients, 81.7% had severe pancreatitis and 47.6% had necrotizing pancreatitis. The modified computed tomography severity score after tigecycline use was similar to that before tigecycline use, but the pancreatic enzymes and infection indices were significantly decreased. The prevalence of TIP was low. Comorbid renal insufficiency was as an independent risk factor for TIP. Tigecycline is safe and efficient for treatment of pancreatitis, especially necrotizing pancreatitis, with intra-abdominal infection.

Motorized spiral enteroscopy – a prospective analysis of 82 procedures at a single tertiary center

Introduction Motorized spiral enteroscopy (MSE) is a promising novel deep enteroscopy technique. The purpose of our study was to evaluate efficiency and safety of MSE in a single tertiary endoscopy center. Methods We prospectively evaluated all consecutive patients undergoing MSE in our endoscopy unit from June 2019 through June 2022. Main outcomes were technical success rate, proportion of procedures with sufficient depth of insertion, success rate of total enteroscopy, diagnostic yield and complication rate. Results A total of 82 examinations in 62 patients (56% males, mean age 58 ± 18 years) were performed, 56 from antegrade and 26 from retrograde approach. Technical success rate was 94% (77/82) and in 89% (72/82) of cases, depth of insertion was considered sufficient. Total enteroscopy was indicated in 19 patients and it was achieved in 16 of them (84%), either by antegrade in 4 or by combined approach in 12 cases. Diagnostic yield was 81%. Lesion of the small bowel was found in 43 of patients. Mean insertion time was 40 for antegrade and 44 min for retrograde procedures, respectively. Complications occurred in 3% (2/62) of patients. One patient suffered from mild acute pancreatitis after total enteroscopy and there was one intussusception of the sigmoid during endoscope withdrawal resolved by parallel colonoscope insertion. Conclusion In our series of 82 procedures in 62 patients examined by MSE during a three-year period, we show high technical success rate (94%), diagnostic yield (81%) and low complication rate (3%).

The Prognostic Consequence of Red Cell Distribution Width in Acute Pancreatitis

INTRODUCTION&#x0D; Acute pancreatitis is commonly a self-limiting disease but, about 25% of patients consequently develop a severe pancreatitis which leads to increase mortality. The available Scoring system is use to predicate severity of the Acute Pancreatitis, which is used for early diagnosis and management. Aim of this study is to assess the association of red blood cell distribution width (RDW) with severity and mortality in patients of acute pancreatitis.&#x0D; MATERIAL AND METHODS&#x0D; This retrospective study was carried out in Department of Surgery of National Medical College and Teaching Hospital. A total of 50 patients with diagnosis as acute pancreatitis over period of March 2020 to February 2022 was included. History and detailed clinical examination was performed as per the working proforma. Blood investigation was done. Data analysis was done using SPSS (Statistical Package for social sciences), version 25.&#x0D; RESULTS&#x0D; Mean age was 39.03 years. 68% cases were female. Acute Biliary was the most common cause. Mean RDW was 12.461, 14.50 and 15.309 in mild, moderate and severe Pancreatitis respectively with a p value of &lt;0.001 showing significant association of RDW and severity of Pancreatitis. Mean RDW in alive was 13.046 and 16.625 in death with a p value of &lt;0.001 showing signifi- cant association between RDW and outcome of acute Pancreatitis.&#x0D; CONCLUSION&#x0D; RDW is a predictor of severity in patients with severe acute pancreatitis.

Abstract #1385190: Empagliflozin Induced Acute Pancreatitis

Acute pancreatitis is a rapid onset inflammatory process of the pancreas which may have local and systemic manifestations. The most common causes of acute pancreatitis are gallstones and alcohol use. Other causes include drug-induced. Sodium-glucose cotransporter-2 (SGLT2) inhibitors are a class of oral hypoglycemic agents which is approved by the FDA for treating diabetes and for heart failure. 56-year-old, female patient known to have uncontrolled type 2 diabetes. Presented with a complaint of acute epigastric pain radiating to the back and then become a generalized abdominal pain, moderate in severity, not relieved by analgesic, associated with nausea and vomiting. The patient denied any history of alcohol, smoking use. A review of her medication list included sitagliptin 100 mg, metformin 2g, gliclazide 60 mg and more recently, empagliflozin 10 mg which was started seven weeks prior to symptoms onset. Physical examination was significant for tenderness in epigastric area. Laboratory workup revealed an elevated serum lipase 3851 units/L, serum amylase 3755 units\L abdominal CT scan shows mild fatty atrophy and mild peri-pancreatic fat stranding and free fluid adjacent to the tale and body suggesting evidence of acute pancreatitis. Abdominal ultrasound shows the gall bladder was without stones. The patient was admitted with diagnosis of mild acute pancreatitis and underwent conservative management. Patient condition was improved and discharged on same pre-admission antidiabetic medication with OPD follow-up. 3 weeks later she presented to the emergency department complaining from acute epigastric pain radiating to the back and association of nausea and vomiting. With tenderness in epigastric area laboratory workup revealed an elevated serum lipase and amylase. Abdominal CT scan confirmed acute interstitial pancreatitis. After 3 days of conservative management she was improved and discharged but this time her diabetologist discontinue empagliflozin and she was started on insulin. She was following up with her diabetologist in outpatient clinic and there was no history of recurrence of pancreatitis. Drug induce pancreatitis are rare cause but must be considered. It is therefore important to determine the underlying etiology of acute pancreatitis to prevent occurrence, recurrence, and the complications of pancreatitis. FDA and Health Canada have identified a potential safety issue and possible association between SGLT-2 inhibitors and acute pancreatitis but Further studies are required to investigate this association. This case report emphasized the possible association between SGLT2 inhibitors and acute pancreatitis. Physicians must be aware about this side effect as a possible cause of acute pancreatitis after exclusion of most common etiologies. Also, physician should inform the patient about the side effects of SGLT2 and the symptoms of acute pancreatitis and advised them to stop SGLT-2 inhibitors use in case such symptoms occur. Further studies are required to investigate this association.