Adherence to the guidelines for treatment of mild biliary acute pancreatitis in the setting of tertiary center in the Czech Republic

Czech version

Authors: Oldřich Stibůrek ¹; Jan Trna ¹; Michal Šenkyřík ¹; Vladimír Prochazka ²; Zdeněk Kala ²; Aleš Hep ¹
Authors‘ workplace: Interní gastroenterologická klinika LF MU a FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Aleš Hep, CSc. ¹; Chirurgická klinika LF MU a FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Zdeněk Kala, CSc. ²
Published in: Vnitř Lék 2014; 60(5-6): 417-422
Category: Original Contributions

Overview

Introduction:
Cholecystectomy (CCX) represents the crucial procedure in preventing relapses of biliary acute pancreatitis (BAP). Endoscopic papilosphincterotomy (EPST) represent an acceptable alternative in patients unsuitable for surgery. Current guidelines recommend patients with mild BAP to undergo CCX in 2 maximally 4 weeks following discharge from the hospital, ideally during the same hospital stay. Adherence to the guidelines differs significantly between particular countries and institutions.

Aim:
To evaluate adherence to the guidelines of BAP management in conditions of tertiary hospital in the Czech Republic.

Methods:
Retrospective analysis of consecutive patients hospitalized in the Clinic of Gastroenterology, University Hospital Brno for acute pancreatitis in years 2007–2012. Cases with both sonographic findings of lithiasis/sludge and 3-fold AST/ALT elevation were considered of clearly biliary etiology.

Results:
We identified 328 patients treated for acute pancreatitis. Clearly biliary etiology was identified in 116 cases (54 male, 62 female). From 114 analyzed patients with complete documentation 81 underwent CCX, 23 were not operated and 10 cases were patients with history of previous CCX. Total mortality of the group was 5.3 %. Out of 81 patients who had CCX was 48 cases of mild BAP. CCX was done during the same hospital stay and/or within 4 weeks from dismissal in 20 patients, therefore, current guidelines were followed in 41.7 % of our study group. Eighteen out of the remaining 28 patients underwent ERCP with EPST. Therefore, within 4 weeks from dismissal 75 % of our patients underwent a procedure (CCX and/or EPST) with a potential to reduce the risk of BAP recurrence. Conclusion: When longer (4 weeks) interval between mild BAP and CCX is applied, the current guidelines are followed in 41.7 % of patients treated at our institution, which is comparable with the literature data. As much as 75 % of our patients underwent a procedure (CCX and/or EPST) with a potential to reduce the risk of BAP recurrence. However, only 12.5 % of index CCX is not favorable outcome that needs improvement. Similar difficulties are being dealt with in the most countries in the World.

Key words:
biliary acute pancreatitis – ERCP – guidelines – cholecystectomy – papilosphincterotomy

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