Pancreatitis Research Articles

Same-admission versus interval cholecystectomy for mild gallstone pancreatitis in pediatric patients

BackgroundThe timing of cholecystectomy for patients with gallstone pancreatitis has been a subject of debate in the past. Data in children are scarce and pediatric guidelines for the management of pancreatitis are mainly based on adult recommendations. The aim of this study was to evaluate the impact of the timing of cholecystectomy on the recurrences of gallstone-related complications and surgery-related complication rates in patients with mild gallstone pancreatitis. MethodsWe conducted a retrospective study on patients with mild gallstone pancreatitis who underwent laparoscopic cholecystectomy between March 2013 and October 2022. Patients were divided into two groups: same-admission cholecystectomy (SAC) and interval cholecystectomy (IC). The primary endpoint was a composite of gallstone-related complications (readmissions before or after cholecystectomy due to recurrent gallstone pancreatitis, choledocholithiasis needing endoscopic retrograde cholangiopancreatography [ERCP] and right upper quadrant [RUQ] pain). Secondary endpoints were total recurrent gallstone pancreatitis events (including those that occurred during the same admission); total number of RUQ pain episodes (regardless of the need for re-hospitalization); residual choledocholithiasis needing postoperative ERCP; cholecystectomy-related difficulties/complications (conversion to open surgery, common bile duct injury, or bleeding), operating time, postoperative length of stay (LOS) and total LOS. ResultsEighty-five patients were included in the analysis. Of these, 47 (55.3 %) had SAC and 38 (44.7 %) interval surgery. Readmissions for gallstone-related complications occurred in 18 (47.4 %) patients in the IC group, compared to 2 (4.3 %) in the SAC group (p = 0.0001). Same-admission cholecystectomy provides a relative risk reduction of readmission of 90.9 %. The incidence of total recurrent gallstone pancreatitis events was higher in the IC group (p = 0.008). Patients in the SAC group had a longer operating time (p = 0.019). There were no differences in the rates of choledocholithiasis needing postoperative ERCP, total number of RUQ pain episodes and total LOS. There were no cholecystectomy-related difficulties/complications in either group. ConclusionIn pediatric patients with mild gallstone pancreatitis, SAC is safe and reduces the risk of readmissions and recurrent gallstone-related complications, compared to IC.

Acute pancreatitis following COVID-19 vaccine: A Vietnamese case report

Several vaccines against the coronavirus 2 that causes severe acute respiratory syndrome have been developed in response to the global coronavirus infectious disease 2019 (COVID-19) pandemic. The FDA has established that the available vaccine is effective against both the original and current SARS-CoV-2 variant infections. The vaccine’s effectiveness and adverse effects also need to be evaluated comprehensively. Although the list of side effects of the mRNA COVID-19 vaccine has been reported, only a few cases of pancreatitis have been documented and published. The mechanism in this situation is unknown, and the onset time from the vaccination to symptom onset is variable through several case reports, so healthcare workers need to be suspicious of pancreatitis to make an early diagnosis and deliver the appropriate treatment. We report a 73-year-old man with controlled chronic hepatitis C and uncomplicated gastritis who presented to the hospital with a 4-day fever accompanied by chills, generalized myalgia, a bilateral temporal dull headache, and no abdominal discomfort or pain. A review of other systems was clinically negative after the second dose of the Pfizer/BioNTech mRNA COVID-19 vaccine. He had no history of alcohol consumption, pancreatitis, or allergic reactions to vaccines and had received the uncomplicated first dose of the Pfizer/BioNTech mRNA COVID-19 vaccine previously. Laboratory tests revealed elevated serum pancreatic enzymes. An abdominal magnetic resonance imaging study showed tail segment enlargement of the pancreas with fat stranding and fluid accumulation surrounding the tail of the pancreas, without any local or systemic complications detected. Other laboratory and imaging tests for the detected source of infections are negative, and acute pancreatitis was diagnosed based on the 2012 revision of the Atlanta classification and definitions by international consensus. The patient was diagnosed with COVID-19 vaccination-induced acute pancreatitis. The patient had an uneventful recovery with no complications. After administering the mRNA COVID-19 vaccine, acute pancreatitis could develop. Therefore, it is crucial to recognize acute pancreatitis when abdominal pain and/or abnormally increased pancreatic enzymes occur following a COVID-19 mRNA immunization.

The possible effects of the aqueous extract of Stevia Rebaudiana on autophagic clearance and sympathetic nerve density in pancreatic β cells of type 2 diabetic rats

BackgroundDiabetes mellitus (DM) is a common metabolic disorder affecting more than 400 million people worldwide. Pancreatic islet cell failure due to partial loss or dysfunction of islet cells is a common feature in type 2 DM. The aim of this study to assess the possible protective role of aqueous extract of stevia on pancreatic β cells of type 2 diabetic rats. MethodsThirty-two male Sprague Dawley rats were divided into four groups; control, control received stevia, type 2 DM and type 2 DM treated with stevia. For all groups; fasting blood glucose, fasting insulin, pancreatic Malondialdehyde (MDA) and Catalase (CAT) were measured. Western blot analysis for measuring LC3 (microtubule associated protein-1 light chain-3) and LAMP2 (lysosomal associated membrane protein 2) was done. Also, histopathological, histomorphometric studies and tyrosine hydroxylase (TH) and norepinephrine (NE) expression by immunostaing in pancreatic tissues were detected. ResultsType 2 DM resulted in a significant increase in fasting blood glucose, pancreatic MDA, LC3 and LAMP2 expression, TH and NE density with a significant decrease in fasting insulin, pancreatic CAT, pancreatic islet area, the number of islets per unit area and the number of β cell per islet. Also, treatment with stevia extract significantly improved the laboratory and histopathological features of pancreas ConclusionStevia extract has protective effects on type 2 DM pancreas by its hypoglycemic and antioxidant actions in addition to its ability to attenuate hyperactive autophagy and sympathetic nerve density.

Risk of acute alcohol pancreatitis is not increased in patients with previous biliary pancreatitis in a long-term follow-up

Risk of acute alcohol pancreatitis is not increased in patients with previous biliary pancreatitis in a long-term follow-up

Serum phosphate levels in acute alcoholic pancreatitis

Serum phosphate levels in acute alcoholic pancreatitis

A data integration approach unveils a transcriptional signature of type 2 diabetes progression in rat and human islets.

Pancreatic islet failure is a key characteristic of type 2 diabetes besides insulin resistance. To get molecular insights into the pathology of islets in type 2 diabetes, we developed a computational approach to integrating expression profiles of Goto-Kakizaki and Wistar rat islets from a designed experiment with those of the human islets from an observational study. A principal gene-eigenvector in the expression profiles characterized by up-regulated angiogenesis and down-regulated oxidative phosphorylation was identified conserved across the two species. In the case of Goto-Kakizaki versus Wistar islets, such alteration in gene expression can be verified directly by the treatment-control tests over time, and corresponds to the alteration of α/β-cell distribution obtained by quantifying the islet micrographs. Furthermore, the correspondence between the dual sample- and gene-eigenvectors unveils more delicate structures. In the case of rats, the up- and down-trend of insulin mRNA levels before and after week 8 correspond respectively to the top two principal eigenvectors. In the case of human, the top two principal eigenvectors correspond respectively to the late and early stages of diabetes. According to the aggregated expression signature, a large portion of genes involved in the hypoxia-inducible factor signaling pathway, which activates transcription of angiogenesis, were significantly up-regulated. Furthermore, top-ranked anti-angiogenic genes THBS1 and PEDF indicate the existence of a counteractive mechanism that is in line with thickened and fragmented capillaries found in the deteriorated islets. Overall, the integrative analysis unravels the principal transcriptional alterations underlying the islet deterioration of morphology and insulin secretion along type 2 diabetes progression.

Effect of activating blood circulation and removing blood stasis on recurrence of alcoholic acute pancreatitis, and the possible underlying mechanism

Purpose: To determine the effect of activating blood circulation and removing blood stasis on the recurrence of alcoholic acute pancreatitis (AAP), and its possible mechanism.Methods: Sixty healthy rats were selected and assigned to control, model and treatment groups (n =20/group). Treatment group was given Taohong Siwu decoction, while control and model groups were given abdominal injection of 0.9 % normal saline. Serum levels of amylase, pancreatic histopathological score, col Ⅰ content, mRNA expression levels of TGF-β 1, TβRII, and Smad3, as well as sPLA2 activity, were determined.Results: Serum amylase, pancreatic histopathological score and col Ⅰ content were significantly reduced in treatment group, relative to model group, while relative mRNA expressions of TGF- β 1, TβRII and Smad3 at each time point were significantly lower than those in the model group (p < 0.05). Serum PLA2 activity and sPLA2 - π a mRNA expression were significantly lower than those in the model group (p < 0.05).Conclusion: Activation of blood circulation and removal of blood stasis significantly prevents the relapse of AAP in rats through regulation of PLA2 activity and TGF-β1/TβRII/Smad3 signaling pathway. Cohort studies in humans would be required to confirm the application of Taohong Siwu decoction to prevent recurrence of AAP.

Cecal Volvulus Presenting after Onset of Acute Pancreatitis: A Case Report

Cecal volvulus is a rare, potentially life-threatening cause of large bowel obstruction (LBO). Discerning LBO in the background of chronic episodes of epigastric or abdominal pain ensures timely treatment and reduces the risk of complications. Atypical demographic presentation may pose a clinical danger that can be best avoided with standardized diagnostic imaging. We report a case of cecal volvulus in a male patient with a history of alcohol use disorder and pancreatitis. The patient underwent a right hemicolectomy with small bowel resection and primary anastomosis.

NLR48 is Better Than CRP, and mCTSI, and Similar to BISAP and SOFA Scores for Mortality Prediction in Acute Pancreatitis: A Comparison of 6 Scores.

The neutrophil-lymphocyte ratio (NLR) has been suggested as a reliable marker for predicting inflammation progression and severity of acute pancreatitis, although the role of the NLR stratified by etiology is still insufficiently studied. However, the NLR's role in mortality prediction was poorly evaluated in the literature. We performed a retrospective, cross-sectional study to analyze the role of NLR0 (at admission) and NLR48 (at 48 hours) in acute pancreatitis as compared with CRP, BISAP, SOFA, and modified CTSI (mCTSI) for the prediction of mortality and severe acute pancreatitis (SAP) in patients admitted into the Emergency Clinical County Hospital of Craiova during 48 months. The primary assessed outcomes were the rate of in-hospital mortality, the rate of persistent organ failure, and ICU admissions. We analyzed mortality prediction for all acute pancreatitis, for biliary, alcoholic, and hypertriglyceridemic acute pancreatitis, for severe forms, and for patients admitted to the ICU. A total of 725 patients were selected; 42.4% had biliary acute pancreatitis, 27.7% had alcoholic acute pancreatitis, and 8.7% had hypertriglyceridemia-induced acute pancreatitis. A total of 13.6% had POF during admission. The AUC for NLR48 in predicting mortality risk and SAP was 0.81 and 0.785, superior to NLR0, CRP48, and mCTSI but inferior to BISAP and SOFA scores. The NLR48/NLR0 ratio did not add significantly to the accuracy. NLR0 and NLR48 performed poorly for mortality prediction in severe forms and in patients admitted to the ICU. NLR48 has good accuracy in our study for predicting death risk in biliary and alcoholic acute pancreatitis but not in hypertriglyceridemic acute pancreatitis. NLR48 was a good indicator in predicting mortality risk and severe forms in all patients with acute pancreatitis, but not of death in SAP and in patients admitted to ICU, with good accuracy for predicting death risk in biliary and alcoholic acute pancreatitis but not in hypertriglyceridemic acute pancreatitis.

Inefficiency in Delivery of General Surgery to Black Patients: A National Inpatient Sample Study.

Background Racial disparities in outcomes among patients in the United States are widely recognized, but disparities in treatment are less commonly understood. This study is intended to identify treatment disparities in delivery of surgery and time to surgery for diagnoses managed by general surgeons-appendicitis, cholecystitis, gallstone pancreatitis, abdominal wall hernias, intestinal obstructions, and viscus perforations. Methods The National Inpatient Sample (NIS) was used to estimate and analyze disparities in delivery of surgery, type of surgery received, and timing of surgery. Age-adjusted means were compared by race/ethnicity and trends in treatment disparities were evaluated from 1993 to 2017. Linear modeling was used to measure trends in treatment and outcome disparities over time. Mediation analysis was performed to estimate contributions of all available factors to treatment differences. Relationships between treatment disparities and disparities in mortality and length of stay were similarly evaluated. Results Black patients were less likely to receive surgery for appendicitis, cholecystitis, pancreatitis, and hernias, and more likely to receive surgery for obstructions and perforations. Black patients experienced longer wait times prior to surgery, by 0.15 to 1.9 days, depending on the diagnosis. Mediation analysis demonstrated that these disparities are not attributable to the patient factors available in the NIS, and provided some insight into potential contributors to the observed disparities, such as hospital factors and socioeconomic factors. Conclusion Treatment disparities are present even with common indications for surgery, such as appendicitis, cholecystitis, and gallstone pancreatitis. Black patients are less likely to receive surgery with these diagnoses and must wait longer for surgery if it is performed. Surgeons should plan institution-level interventions to measure, explain, and potentially correct treatment disparities.

S120 Comparison of Local and Systemic Complications of Acute Biliary and Alcoholic Pancreatitis in the US 2016-2020: A Propensity Matched Analysis

S120 Comparison of Local and Systemic Complications of Acute Biliary and Alcoholic Pancreatitis in the US 2016-2020: A Propensity Matched Analysis

S1217 Factors That Impact Patients Who Present With Acute Gallstone Pancreatitis Who Undergo ERCP vs ERCP + Cholecystectomy

S1217 Factors That Impact Patients Who Present With Acute Gallstone Pancreatitis Who Undergo ERCP vs ERCP + Cholecystectomy

S39 Impact of Frailty on Acute Alcoholic Pancreatitis Outcomes: A Nationwide Readmissions Database Study

S39 Impact of Frailty on Acute Alcoholic Pancreatitis Outcomes: A Nationwide Readmissions Database Study

Method of Choice for Pancreatic Enteroanastomosis Formation in Patients with Chronic Pancreatitis and Malignant Neoplasms of Pancreas

Introduction. Pancreatic enteroanastomosis formation is a decisive stage of the entire operation, as the frequency of complications leading to death remains high.The aim of the study was to improve the clinical outcomes of surgical interventions on pancreas by choosing the proper technique for pancreatic enteroanastomosis formation.Materials and methods. A retrospective-prospective study was performed in the Center for Surgery of the Liver, Pancreas and Biliary Tracts, Ryazan State Medical University. The retrospective stage included the analysis of 270 operation protocols and case histories of patients undergone pancreatic resection. Based on the analysis, the academic staff of the Department of Hospital Surgery, Ryazan State Medical University, developed a technique for pancreatic jejunoanastomosis via through U-shaped sutures (the modified Blumgart-style pancreaticojejunostomy).The prospective stage included analysis of 98 case histories and operation protocols of patients undergone pancreatic resection. There were 73 patients with chronic pancreatitis and 25 patients with the head of the pancreas cancer. Groups were formed uniformly depending on the etiology.Statistical analysis methods included: multivariate correlation analysis using the contingency coefficient (); Shapiro-Wilk test; Pearson's chi-squared test; one-way ANOVA test and multiple comparison method with Bonferroni correction for Student's t-test.Results. Correlation between the infiltrated pancreas and the frequency of complications - was 0.517.The frequency of anastomosis failure with the PD diameter 3 - was 0.167, with PG3mm - = 0.358.The infiltrated parenchyma of the pancreas and the PD diameter 3 mm affected the incidence of postoperative complications - = 0.387 (PG 3 mm, the incidence of postoperative complications - = 0.254).At the reconstructive stage, patients of group 1 were exposed to pouch-invagination pancreatic enteroanastomosis end-to-side, patients of group 2 were exposed to pancreatic enteroanastomosis using nodular sutures, patients of group 3 were exposed to pancreatic jejunoanastomosis using through U-shaped sutures, the modified Blumgart-style pancreaticojejunostomy. In patients from group 1 complications were observed in 58% of cases, in patients from group 2 complications were observed in 45.4% of cases, in patients from group 3 complications were observed in 20.5% of cases (p=0.010). Pancreatic enteroanastomosis failed in 29% of patients from group 1, and in 21.2% of patients from group 2; in patients from group 3 no pancreatic enteroanastamosis failure was observed (p = 0.003). There were 9.7% of gastrostasis cases in patients from group 1, 9.1% of gastrostasis cases in patients from group 2, 8.8% of gastrostasis cases in patients from group 3 (p = 0.1). Postoperative pancreatitis was observed in 12.9% of patients from group 1, in 9.1% of patients from group 2, in 5.9% of patients from group 3 (p=0.015). Twenty-nine percent of patients from group 1, 18.1% of patients from group 2, 2.9% of patients from group 3 required repeated surgical interventions.Conclusions. In case of through U-shaped sutures application, repeated surgical interventions for pancreatic jejunoanastomosis were performed in 2.9% of cases, the rate of postoperative complications was 20.5%, no anastomosis failure was observed.Pancreatic jejunoanastomosis using through U-shaped sutures has proven to be more effective compared to other pancreatic enteroanastomosis techniques applied in clinical practice. It can be used in educational and pedagogical and research activities in medical universities.

Time to interval cholecystectomy and associated outcomes in a population aged 50 and above with mild gallstone pancreatitis

BackgroundCholecystectomy on index admission for mild gallstone pancreatitis (GSP) is recommended, although not always feasible. This study examined rates and outcomes of people aged ≥ 50 years who underwent interval (delayed) cholecystectomy at increasing time points.MethodsHospitalisation and death data were linked for individuals aged ≥ 50 years admitted to hospital in New South Wales, Australia with mild GSP between 2008–2018. Primary outcome was interval cholecystectomy timing. Secondary outcomes included mortality, emergency readmission for gallstone-related disease (GSRD) (28 and 180-day), and length of stay (LOS) (index admission and total six-month GSRD).Results3,003 patients underwent interval cholecystectomy: 861 (28.6%) at 1–30, 1,221 (40.7%) at 31–90 and 921 (30.7%) at 91–365 days from index admission. There was no difference in 365-day mortality between groups. Longer delay to cholecystectomy was associated with increased 180-day emergency GSRD readmission (17.5% vs 15.8% vs 19.9%, p < 0.001) and total six-month LOS (5.9 vs 8.4 vs 8.3, p < 0.001). Endoscopic retrograde cholangiopancreatography (ERCP) was increasingly required with cholecystectomy delay (14.5% vs 16.9% vs 20.4%, p < 0.001), as were open cholecystectomy procedures (4.8% vs 7.6% vs 11.3%, p < 0.001). Extended delay was associated with patients of lower socioeconomic status, regional/rural backgrounds or who presented to a low volume or non-tertiary hospital (p < 0.001).ConclusionDelay to interval cholecystectomy results in increased rates of emergency readmission, overall LOS, risks of conversion to open surgery and need for ERCP. Index admission cholecystectomy is still recommended, however when not possible, interval cholecystectomy should be performed within 30 days to minimise patient risk and healthcare burden.

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.

1268 An Audit of the Time to Surgery Following Diagnosis of Gallstone Pancreatitis

Abstract Aim To assess the compliance of our trust with the British Gastroenterology guidelines (BSG) on the management of gallstone pancreatitis which recommends that patients should undergo definitive treatment of laparoscopic cholecystectomy during the index admission or within 2 weeks of discharge to prevent readmission with biliary complications. Method This was a retrospective study of patients admitted with gallstone pancreatitis over a 3-month period between January 2021 and March 2021. We collected data from electronic medical records (EPR) and collated them on Microsoft Excel. Data was gathered on patient demographics, diagnosis at presentation, number of days to surgery, rate of readmission and the reasons for this. Results A total of 21 patients were admitted with gallstone pancreatitis. The median age was 50 years and 52% of them were male. 14 (67%) patients had laparoscopic cholecystectomy and only 9 (64%) of these had it within the 2-week window. 7 (33%) patients did not have surgery. Of these, 4 of them were not eligible, 1 went private and 2 patients are still awaiting surgery. The median wait for surgery was 3 days. The average time to surgery was 64 days. There were 6 readmissions whilst waiting for surgery with pain being the most common reason. Conclusions 64% of patients had definitive treatment of laparoscopic cholecystectomy within the 2-week time frame demonstrating poor compliance with the BSG guidelines. We have introduced a semi-emergency theatre list once a week to accommodate definitive management of patients with gallstone pancreatitis and will re-audit the data to evaluate for improvement.

1158 Outcome of Hot Laparoscopic Cholecystectomy Service Evaluation in Morriston Hospital, SBUHB

Abstract Aim Symptomatic Gall Bladder disease is a common general surgery presentation. NICE guidelines recommend performing laparoscopic cholecystectomy (within 1 week of diagnosis) for patients with acute cholecystitis. Patients who had gall stone pancreatitis should have laparoscopic cholecystectomy on the index admission. Historically poor availability of theatre slots has resulted in unacceptable delays in our health board. The objective of this study was to evaluate adherence to these recommendations before and after an intervention to improve theatre access. Method A retrospective study of inpatient laparoscopic cholecystectomies between 20/06/2022 and 28/11/2022 was undertaken in Morriston Hospital. On 20/09/2022, dedicated theatre lists for laparoscopic cholecystectomy were moved from afternoon sessions to morning or all-day sessions with the intention of minimising delays. Baseline patient and operative details were captured from electronic health records. Outcomes were adherence to recommendations from NICE and time to procedure from booking and number of procedures done before and after the intervention. Result 85 patients were included (42 patients before (Group 1) and 43 after the intervention (Group 2). 100% of patient from group 1 received cholecystectomy within a week of booking compared to 86% from group 2 (P = 0.09). Mean time to procedure was 2.5 days and 3.5 days for group 1 and group 2 respectively (P = 0.076). 3.5 patients received cholecystectomy per week in group 1 as compared to 4.4 in group 2. Conclusions Changing the timing of Theatre lists from Afternoon to Morning/all day resulted in more patients receiving cholecystectomies without compromising time from booking to procedure

1162 Management of Acute Gallstone Disease at an Urban Acute Trust During the Pandemic – Closed-Loop Audit

Abstract Aim Acute gallstone disease is a surgical emergency with emphasis on early surgery (Laparoscopic Cholecystectomy (LC)) to improve outcomes. Method Patients presenting with acute cholecystitis, biliary colic, and gallstone pancreatitis between September and December 2021 were retrospectively audited. We measured re-admission rates, emergency and elective cholecystectomies performed, and interval between operation and initial admission. This revealed a need for improvement in the service provided at this trust. An intervention was implemented with the Hot Cholecystectomy list being available for other surgeons as well as encouraging acute LC on the Emergency theatre list. A follow-up retrospective audit was carried out between July and September 2022 using the same criteria as per the initial data collection. Results 240 patients were admitted with acute gallstone disease during the initial audit period. At the end of audit period, 49 patients underwent LC, of which only 20% were performed acutely. However, 70% of acute operations were performed during re-admissions. During the re-audit, 109 patients were admitted with acute gallstone disease. Within the three months, 21% of patients underwent LC, out of which 52% were acute operations. 50% of the emergency operations were in re-admission patients. Patients from the initial audit were followed up which revealed average waiting time of 118.5 days from admission to LC Conclusions There was almost a 3-fold increase in the rate of Emergency LC post intervention. While there is an increase, provision of emergency cholecystectomies does not comply with national guidelines. Resources need to be allocated nationwide for timely treatment of acute gallstone disease.

FTP7.9 Not all necrotising pancreatitis are the same: does aetiology affect the extent pancreatic necrosis? A single-centre retrospective study

Abstract Aim To assess the extent of pancreatic necrosis (PN) on abdominal computed tomography (CT) in patients with acute gallstone pancreatitis (GP) and alcohol-induced pancreatitis (AIP). Methods Patients ≥ 18-year-old with first-time onset of GP, AIP and PN on CT scan, from January 2010 to September 2018, were included. Extent of PN on CT, organ failure rate, admission to the intensive care unit (ICU), were compared between GP (group 1) and AIP (group 2). PN extent was described as: localised – right or left of the midline; diffuse – across the midline; more/less than 50% of the pancreas. Analysis of continuous and categorical data and multiple logistic regression were conducted. Significance was set at p&amp;lt;0.05. Results One hundred-two consecutive patients, 66 in group 1, 36 in group 2, were included. Overall, diffuse PN occurred in 34.3% of cases, more frequently in group 1 (42.4% vs 19.4%, p=0.03). Single/multiorgan failure developed in 50 patients, 57.6% belonged to group 1 (p=0.03). Predictors of organ failure were diffuse pattern of PN (OR 2.70, 95% CI 1.03 to 7.03, p=0.004) and PN ≥50% (OR 5.50, 95% CI 1.39 to 21.6, p=0.01). Admission to ICU was required in 27 subjects; PN ≥50% predicted ICU admission (OR 8.93, 95% CI 2.68 to 29.73, p=0.0004). The median hospital stay was 12 days (range 1-265), longer in group 1 (12.5 vs 10.5, p=0.02). Conclusions Diffuse PN occurred more frequently in patients with GP. A larger extent of PN predicted the onset of single/multiorgan failure and admission to the ICU.