UEGJournal Abstracts 2021 - 739
Pancreas
P0811
INVALIDITY OF TOKYO-GUIDELINES IN ACUTE BILIARY PANCREATITIS:
A PROSPECTIVE, INTERNATIONAL, MULTICENTER COHORT ANALYSIS OF
944 PANCREATITIS CASES
M.F. Juhász1
, N. Farkas1, V. Jászai2
, R. Tóháti2
, R. Molnár2
A. Vincze3, A. Szentesi1,4, P. Hegyi4,1,5, A. Parniczky6,1
1Institute for Translational Medicine, Medical School, University of
Pécs, Pécs, Hungary, 2
3University of Pécs, First Department of Medicine, Medical School,
Pécs, Hungary, 4
Medicine, Department of Medicine, Szeged, Hungary, 5
University of Szeged, Centre for Translational
Division
of Translational Medicine, First Department of Medicine, Medical
School, University of Pécs, Pécs, Hungary, 6
Insitute of Pediatrics, Budapest, Hungary
Heim Pál National
Contact E-Mail Address: flixjuhsz@gmail.com
Introduction: Acute pancreatitis (AP) guidelines are incomplete regarding
the indications and initiation of antibiotic therapy. Adequate reasons for
antibiosis in AP include cholangitis (CA) and cholecystitis (CC). The picture
seen in biliary AP shows significant overlap with the diagnostic criteria
(Tokyo criteria) for CA and CC. Their validity, together with the antibiotic
practice in biliary AP are questionable.
Aims & Methods: Our aim was to examine the fulfilment of Tokyo criteria
in biliary AP, antibiotic practice, and evaluate associations with patientimportant
outcomes.
We conducted a secondary analysis of the Hungarian Pancreatic Study
Group's (HPSG) multicenter, international, prospectively collected registry
of AP patients. We evaluated abdominal imaging results to determine Tokyo
guideline fulfilment and severity, together with data already collected
in the registry. Chi-square and Fisher exact tests were used.
Results: Out of 944 biliary AP patients, 77.3% received antibiotics (mostly
ceftriaxone and metronidazole). 31.1% of patients fulfilled the diagnostic
criteria for both CA and CC, 24.8% for CC only and 17.5% for CA only. While
mortality in severe cases that seemingly fulfilled the Tokyo guidelines for
CC or CA was 20.8% and 12.8% respectively, it was below 1% in moderate
and mild cases.
Conclusion: Around 75% of biliary AP patients fulfilled the diagnostic criteria
for CA/CC, leading to a high rate of antibiotic use. As cohort studies
are ill-suited to answer interventional questions, a randomized controlled
trial should be performed to evaluate the need for antibiotics in questionable
CA cases.
Disclosure: Nothing to disclose.
Semmelweis University, Budapest, Hungary,
,
P0812
LACTATED RINGER'S SOLUTION DOES NOT REDUCE INFLAMMATION
IN ACUTE PANCREATITIS - A META-ANALYSIS
K. Ocskay1, Z. Vinkó2, A.É. Ocskay3
A. Parniczky6
1
, N. Gede4
, P. Hegyi5
,
Faculty of Medicine, University of Pécs, Institute for Translational
Medicine, Vértesboglár, Hungary, 2
Faculty of Medicine, University
of Pécs, Institute for Translational Medicine, Pécs, Hungary,
3
University of Pécs, Pécs, Hungary, 5
University of Pécs, Institute for Translational Medicine, Pécs,
Hungary, 4
Institute for Translational Medicine, Medical School,
University of Pecs, Centre for
Translational Medicine, Pecs, Hungary, 6Heim Pál National Insitute
of Pediatrics, Translational Medicine, Budapest, Hungary
Contact E-Mail Address: ocskay.klementina@gmail.com
Introduction: Early fluid resuscitation has an essential role in the treatment
of acute pancreatitis (AP). The quantity and quality of the administered
fluid have long been studied, but the benefits of lactated Ringer's
(LR) solution are not yet clear.
Aims & Methods: To assess the benefits of LR in AP. The protocol was registered
on Prospero (CRD42021224542). The search was conducted on the
20th of November 2020 in MEDLINE (via PubMed), EMBASE, Scopus, Web
of Science and CENTRAL to identify randomized controlled trials comparing
LR to normal saline (NS) in AP patients. Risk ratios (RR) or mean differences
(MD) with 95% confidence interval (CI) were calculated. Leave-oneout
sensitivity analysis and trial sequential analysis (TSA) were conducted.
The RoB2 tool and GRADE approach were used for risk of bias and quality
of evidence (QoE) assessment.
Results: From 798 records seven studies were included. LR significantly
reduced the need for intensive care (RR 0.50, CI 0.30 to 0.85, low QoE). The
risk for organ failure was not reduced (RR 0.82, CI 0.61 to 1.12, very low
QoE) along with the risk for systemic inflammatory response syndrome
(SIRS) at 24 and 48 hours (RR 0.68, CI 0.31-1.52; RR 0.79, CI 0.44-1.43, low
QoE). The decrease of C-reactive protein levels at 48 hours (mean CRP
change: - 54.14 mg/l, CI: -130.28 to 21.99, very low QoE) was not significant.
To assess necrosis (RR 0.50; CI 0.26 to 0.96, very low QoE) and length
of hospitalization (MD -1.32, CI -2.62 to -0.01, very low QoE) further studies
are necessary. TSA demonstrated sample size reaching the required value
for need for intensive care and organ failure only. The majority of the studies
carried low risk of bias.
Conclusion: LR does not seem to prevent the development of SIRS and to
reduce CRP levels compared to NS in AP. Furthermore, we showed that LR
reduces the need for intensive care but not organ failure.
Disclosure: Nothing to disclose.
P0813
TECHNICAL EVOLUTION OF ENDOSCOPIC ULTRASOUND-GUIDED
DRAINAGE OF WALLED-OFF NECROSIS
D. Ramos Silva1
A. Caldeira1
, M. Linhares1
, I. Pestana1
, A.J. Duarte Banhudo1
1Hospital Castelo Branco, Castelo Branco, Portugal
Contact E-Mail Address: ramos.diana92@gmail.com
Introduction: Walled-off necrosis (WON) is a late complication of severe
acute pancreatitis that may require intervention. Endoscopic drainage
has been increasingly used as a minimally invasive alternative to surgical
drainage, and the endoscopic technique has evolved over the years.
Aims & Methods: Evaluate the clinical results, success rates and adverse
events of endoscopic WON drainage, comparing the different techniques
and types of stents used over time at our center.
Vol. 9 | October 2021
739
, M. Pereira1
, E. Pereira1
,
UEGJournal Abstracts 2021
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