Evaluating approaches to diagnosis and management of idiopathic acute pancreatitis
Copyright © 2023. Published by Elsevier Ltd..
INTRODUCTION: Idiopathic acute pancreatitis (IAP) is a diagnosis of exclusion; systematic work-up is challenging but essential. Recent advances suggest IAP results from micro-choledocholithiasis, and that laparoscopic cholecystectomy (LC) or endoscopic sphincterotomy (ES) may prevent recurrence.
METHODS: Patients diagnosed with IAP from 2015-21 were identified from discharge billing records. Acute pancreatitis was defined by the 2012 Atlanta classification. Complete workup was defined per Dutch and Japanese guidelines.
RESULTS: A total of 1499 patients were diagnosed with IAP; 455 screened positive for pancreatitis. Most (N = 256, 56.2%) were screened for hypertriglyceridemia, 182 (40.0%) for IgG-4, and 18 (4.0%) MRCP or EUS, leaving 434 (29.0%) patients with potentially idiopathic pancreatitis. Only 61 (14.0%) received LC and 16 (3.7%) ES. Overall, 40% (N = 172) had recurrent pancreatitis versus 46% (N = 28/61) following LC and 19% (N = 3/16) following ES. Forty-three percent had stones on pathology after LC; none developed recurrence.
CONCLUSION: Complete workup for IAP is necessary but was performed in <5% of cases. Patients who potentially had IAP and received LC were definitively treated 60% of the time. The high rate of stones on pathology further supports empiric LC in this population. A systematic approach to IAP is lacking. Interventions aimed at biliary-lithiasis to prevent recurrent IAP have merit.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:25 |
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| Enthalten in: |
HPB : the official journal of the International Hepato Pancreato Biliary Association - 25(2023), 10 vom: 01. Okt., Seite 1187-1194 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Wehrle, Chase J [VerfasserIn] |
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| Anmerkungen: |
Date Completed 29.09.2023 Date Revised 02.10.2023 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.hpb.2023.04.016 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM357139542 |
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| 245 | 1 | 0 | |a Evaluating approaches to diagnosis and management of idiopathic acute pancreatitis |
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| 500 | |a Date Revised 02.10.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023. Published by Elsevier Ltd. | ||
| 520 | |a INTRODUCTION: Idiopathic acute pancreatitis (IAP) is a diagnosis of exclusion; systematic work-up is challenging but essential. Recent advances suggest IAP results from micro-choledocholithiasis, and that laparoscopic cholecystectomy (LC) or endoscopic sphincterotomy (ES) may prevent recurrence | ||
| 520 | |a METHODS: Patients diagnosed with IAP from 2015-21 were identified from discharge billing records. Acute pancreatitis was defined by the 2012 Atlanta classification. Complete workup was defined per Dutch and Japanese guidelines | ||
| 520 | |a RESULTS: A total of 1499 patients were diagnosed with IAP; 455 screened positive for pancreatitis. Most (N = 256, 56.2%) were screened for hypertriglyceridemia, 182 (40.0%) for IgG-4, and 18 (4.0%) MRCP or EUS, leaving 434 (29.0%) patients with potentially idiopathic pancreatitis. Only 61 (14.0%) received LC and 16 (3.7%) ES. Overall, 40% (N = 172) had recurrent pancreatitis versus 46% (N = 28/61) following LC and 19% (N = 3/16) following ES. Forty-three percent had stones on pathology after LC; none developed recurrence | ||
| 520 | |a CONCLUSION: Complete workup for IAP is necessary but was performed in <5% of cases. Patients who potentially had IAP and received LC were definitively treated 60% of the time. The high rate of stones on pathology further supports empiric LC in this population. A systematic approach to IAP is lacking. Interventions aimed at biliary-lithiasis to prevent recurrent IAP have merit | ||
| 650 | 4 | |a Journal Article | |
| 700 | 1 | |a Stackhouse, Kathryn A |e verfasserin |4 aut | |
| 700 | 1 | |a Chang, Jenny |e verfasserin |4 aut | |
| 700 | 1 | |a Hossain, Mir S |e verfasserin |4 aut | |
| 700 | 1 | |a McMichael, John |e verfasserin |4 aut | |
| 700 | 1 | |a Roy, Mayank |e verfasserin |4 aut | |
| 700 | 1 | |a Augustin, Toms |e verfasserin |4 aut | |
| 700 | 1 | |a Naffouje, Samer |e verfasserin |4 aut | |
| 700 | 1 | |a Joyce, Daniel |e verfasserin |4 aut | |
| 700 | 1 | |a Simon, Robert |e verfasserin |4 aut | |
| 700 | 1 | |a Walsh, R Matthew |e verfasserin |4 aut | |
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