Evidence Based Management of Acute Biliary Pancreatitis

Zagazig University

Status: Completed

Conditions: Acute Pancreatitis

Treatments: Procedure: open necrosectomy; Procedure: Endoscopic ultrasound (EUS) guided aspiration for infected necrosis; Combination Product: NSAID / paracetamol +/- opiates+/- epidural analgesia; Procedure: Endoscopic transmural cystogastrostomy; Drug: Ringer lactate; Device: EUS /Secretin-stimulated magnetic resonance cholangiopancreatography (MRCP); Procedure: retroperitoneal necrosectomy; Device: CT; Device: nasogastric tube; Device: ultrasound; Diagnostic Test: Liver enzymes (Bilirubin, alanine transferase (ALT), aspartate aminotransferase, (AST) and alkaline phosphatase). Calcium. Triglycerides.; Diagnostic Test: serum lipase or amylase; Procedure: percutaneous catheter drainage (PCD) for infected necrosis; Combination Product: Quinolones + Metronidazole /Carbapenems ± Metronidazole; Procedure: open cystogastrostomy; Dietary Supplement: Fresubin 2Kcal fiber drink

Study type: Observational

Funder types: Other

Identifiers

NCT04615702

acute panreatitis guidelines

Details and patient eligibility

About

This study aims to assess the outcome of standardized evidence-based care to all patients with acute biliary pancreatitis treated at surgery department, Zagazig University hospitals during the period from may, 2017 to may 2019.

Full description

Acute pancreatitis (AP) is one of the most important gastrointestinal disorders causing emotional and physical human burden . The annual incidence worldwide for AP is 4.9-73.4 cases per 100,000 people and the overall mortality rate is 4 to 8%, which increases to 33% in patients with infected necrosis. AP is diagnosed when two of three criteria are fulfilled: typical abdominal pain of AP, more than three times elevated serum amylase/lipase level and signs of AP on imaging.

It is necessary to clarify the etiology of AP promptly. The diagnosis of gallstones, as the leading cause for AP, should have the top priority as that will direct the treatment policy. Long standing alcohol consumption and gallstones disease incriminated in the majority of cases with AP. Small common bile duct stones, in particular, are the cause of AP in approximately 32 to 40% of cases. In 10-30% of cases, the cause is unknown, so studies have suggested that up to 70% of cases of idiopathic pancreatitis are secondary to biliary microlithiasis.

The pathogenesis of biliary AP has been intensively investigated. Many theories explain how gallstones can trigger AP. The predominant theories include common pathway theory and gallstone migration theory. In general, AP occurs when intracellular protective mechanisms fail to prevent trypsinogen activation or reduce trypsin activity.

It is important that management of such potentially life threatening condition to be guided by an evidence-based approach. After comparing the Japanese (JPN) Guidelines 2015 and its former edition 2010 with the other two guidelines, International Association of Pancreatology/American Pancreas Association guidelines (IAP/APA), 2013 and American College of Gastroenterology (ACG), 2013, the JPN Guidelines, 2015 proved to be the highest quality regarding its systematic literature review prepared by the meta-analysis team, including the grading of recommendations and providing pancreatitis bundles.

Enrollment: 30 patients

Sex: All

Volunteers: No Healthy Volunteers

Inclusion criteria

• all cases with acute biliary pancreatitis

Exclusion criteria

• all cases with non biliary pancreatitis

Trial design

30 participants in 1 patient group

application of recent guidelines in the management of acute biliary pancreatitis

Description:

all patients subjected to the following: Confirmation of the diagnosis of acute pancreatitis, Diagnosis of the cause either biliary or not, Severity scoring and Evidence based management regarding Initial management, Intervention as indicated, Prevention of recurrence and Follow up

Treatment:

Device: EUS /Secretin-stimulated magnetic resonance cholangiopancreatography (MRCP)

Device: nasogastric tube

Device: ultrasound

Device: CT

Procedure: retroperitoneal necrosectomy

Procedure: percutaneous catheter drainage (PCD) for infected necrosis

Diagnostic Test: serum lipase or amylase

Diagnostic Test: Liver enzymes (Bilirubin, alanine transferase (ALT), aspartate aminotransferase, (AST) and alkaline phosphatase). Calcium. Triglycerides.

Dietary Supplement: Fresubin 2Kcal fiber drink

Combination Product: Quinolones + Metronidazole /Carbapenems ± Metronidazole

Procedure: Endoscopic ultrasound (EUS) guided aspiration for infected necrosis

Procedure: open cystogastrostomy

Procedure: open necrosectomy

Combination Product: NSAID / paracetamol +/- opiates+/- epidural analgesia

Drug: Ringer lactate

Procedure: Endoscopic transmural cystogastrostomy