PDF | https://doi.org/10.46613/congastro2023-193
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Salgado P1, Puga M2, Castells J3, Gallegos A1, Alcivar M1, Serrano A1, Aynaguano L1, Guaranda M1, Marriott D4, Teran Z1, Vera E1, Jara M1, Yepez S1, Carrillo J1, Vega C1, Oleas R5, Arevalo M4, Buchelli P3, Carvajal J6, Cartagena M7, Marriott E4
1Hospital Teodoro Maldonado Carbo (HTMC), Guayaquil, Ecuador
2Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
3Universidad Católica de Santiago de Guayaquil (UCSG), Guayaquil, Ecuador
4Universidad de Especialidades Espíritu Santo (UEES), Guayaquil, Ecuador
5John H. Stroger, Jr. Hospital of Cook County, Chicago, Estados Unidos (EEUU)
6Universidad Santiago de Chile, Santiago, Chile
7Hospital El Carmen, Santiago, Chile
BACKGROUND: Hospitalisation and endoscopic resources are necessary to achieve the best management in acute pancreatitis (AP) patients. A better comprehension of AP epidemiology per institution contributes to healthcare resource planning.
AIM: To characterise AP epidemiology at a tertiary hospital in terms of aetiology, severity, management, hospitalisation length, complications, and mortality rate.
METHODS: Historic cohort study between Jan’2013 to Apr’2018. The following data was recovered from the electronic records: demographics, AP aetiology and severity, endoscopic ultrasound (EUS) diagnosis, requirement of parenteral nutrition (PN), endoscopic retrograde cholangiopancreatography (ERCP), hospitalisation length, complications and mortality rate.
RESULTS: 532 patients, mean age 53.0 ± 20.1 years old, 284 women (53.4%), 61 cholecystectomy (11.5%). AP aetiology was biliary (382; 71.9%), post-ERCP (59; 11%), alcohol-related (48; 9%), cancer-related (28; 5.3%), drug-related (1; 0.2%), autoimmune pancreatitis (1; 0.2%), and idiopathic (13; 2.4%). According to Marshall, BISAP, Ranson score, and Balthazar grade, 6%, 6%, 5.5%, and 3.6% were at high-risk mortality, respectively. EUS was required in 260 (48.9%). Oral feeding was successfully restarted within the first five days post-AP onset in 428 (80.5%), but 81 required PN (15.2%). ERCP was performed in 400 (75.2%), without ERCP-related complications in 399 (99.7%). One patient presented post-ERCP pancreatitis (0.3%). There were 402/471 non-cholecystectomy patients addressed to post-ERCP cholecystectomy (85.4%). The median hospitalisation length was two days. Early local complications were identified in 45 (8.5%): 40 acute peripancreatic free collections and five acute necrotic collections. Late local complications were identified in 18 (3.4%): seven pseudocysts and eleven walled-off necrosis. The mortality rate was 1/532 (0.2%).
CONCLUSIONS: In general, high-risk mortality patients remain low. EUS and ERCP played an important diagnostic and therapeutic role. There was a few PN requirement and hospitalisation length. Around 1 per 10 patients presented local complications. This data helps plan improvement on institutional strategies to optimise outcomes.