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Are the current diagnostic criteria for acute cholangitis applicable in patients with acute biliary pancreatitis?
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BILIARY 0544 CONCOMITANT VASCULAR INJURIES ASSOCIATED WITH POSTCHOLECYSTECTOMY IATROGENIC BILE DUCT INJURIES: INCIDENCE AND MANAGEMENT IN A HIGH VOLUME CENTER O. Hegazy, H. Soliman, H. Shoreen, S. Saleh, T. Yassin and G. Said National Liver Institute, Egypt Aims: Concomitant vascular injury with post cholecystectomy bile duct injury is possible. It is considered as an increasing finding during repair. Thus, assessment of those injuries is crucial for defining the optimal surgical management. Methods: One hundred and thirty patients were managed surgically for post cholecystectomy bile duct injury between January 2010 and December 2014 in the department of HPB surgery, National Liver Institute, Menoufiya University in Egypt. Patient’s records were revised including preoperative, intraoperative and postoperative data. Follow up visits were also revised. Vascular injury was identified intra-operatively at the beginning of the study while, later, all patients were carried out Computed Topographic hepatic angiography. Results: Twenty eight patients had concomitant vascular injury. Majority were females (75%) with mean age 35years (range, 30e50years). Most of the injuries were post open cholecystectomy (71%). All the patients had right hepatic artery injury while seven had added right portal vein injury. Fifteen patients had right hepatectomy and left hepatico-jejunostomy (53%). Three patients died (11%) due to sepsis and multi-organ failure. The remaining patients had conventional hepatico-jejunostomy. Conclusions: Assessment of vascular injury is an important part in the management of patients with bile duct injuries. Isolated arterial or combined portal injuries may lead to hepatectomy while mortality occurred due to cholangitic abscesses, severe cholangitis with subsequent sepsis.
PANCREATITIS 563 ARE THE CURRENT DIAGNOSTIC CRITERIA FOR ACUTE CHOLANGITIS APPLICABLE IN PATIENTS WITH ACUTE BILIARY PANCREATITIS? N. J. Schepers1,2, O. J. Bakker3, U. A. Ali3, E. J. M. van Geenen4, H. C. van Santvoort5, M. G. Besselink5 and M. J. Bruno1 1 Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam; 2Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein; 3Department of Surgery, University Medical Center Utrecht, Utrecht; 4Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical
Center, Nijmegen; 5Department of Surgery, Academic Medical Center, Amsterdam, Netherlands Aims: In patients with acute biliary pancreatitis and concomitant cholangitis, urgent endoscopic retrograde cholangiography (ERC) is indicated. However, a definition for cholangitis during acute biliary pancreatitis is lacking. The aim of this study was to evaluate the recent Tokyo Guidelines (TG13) for acute cholangitis in patients with acute biliary pancreatitis. Methods: We performed a post hoc analysis of a prospective database of 731 patients with acute pancreatitis included in 15 Dutch hospitals. ERC within 72 h after admission was considered an ‘early ERC’. We evaluated which patients fulfilled the TG13 criteria for acute cholangitis, described the findings during ERC and the clinical outcome. Results: In total 418 out of 731 patients suffered from acute biliary pancreatitis. In the first 72 h of admission, classification according to the TG13 criteria was: 1. no cholangitis (n=147, 35%); 2. suspected cholangitis (n=212, 51%); and 3. definitive cholangitis (n=59, 14%). An ‘early ERC’ was performed in 34 patients (23%) with no cholangitis, 110 patients (52%) with suspected cholangitis, and 54 patients (92%) with definitive cholangitis. Purulent bile was observed during ERC in similar frequency in all 3 groups (3% vs. 9% vs. 11%, P=0.24). Patients with suspected cholangitis in whom an early ERC was performed had similar outcomes compared with patients treated without ERC in terms of mortality (16% vs. 15%, P=0.74), infected pancreatic necrosis (15% vs. 15%, P=0.97), bacteremia (18% vs. 15%, P=0.50) and intensive care unit admission (17% vs. 21%, P=0.54). No significant differences in outcomes were observed between early ERC or conservative treatment in patients with definitive or no cholangitis. Conclusions: Acute cholangitis in the early phase of acute biliary pancreatitis tends to be over-diagnosed when using the TG13 diagnostic criteria potentially leading to unnecessary ERC’s. Accordingly, a more accurate definition is needed for the assessment of acute cholangitis during acute biliary pancreatitis.
BILIARY 0670 POSTOPERATIVE ANTIBIOTIC USE IN THE TREATMENT OF ACUTE CHOLECYSTITIS: A RANDOMIZED MULTICENTRE NONINFERIORITY TRIAL C. S. Loozen1, J. E. Oor1, K. Kortram1, A. W. van Geloven2, P. van Duijvendijk3, G. A. Nieuwegenhuijzen4, S. C. Donkervoort5, A. Gobel1, B. J. Vlaminckx1, C. A. Knibbe1, J. C. Kelder1, V. N. Kornmann1, M. G. Besselink6, B. van Ramshorst1, D. J. Gouma6, H. C. van Santvoort1 and D. Boerma1 1 St Antonius Hospital; 2Tergooi Hospital Hilversum; 3 Gelre Hospitals Apeldoorn; 4Catherina Hospital Eindhoven; 5Onze Lieve Vrouwe Hospital Amsterdam; 6 Academic Medical Centre Amsterdam, Netherlands
HPB 2016, 18 (S2), e854ee856
BILIARY 0544 CONCOMITANT VASCULAR INJURIES ASSOCIATED WITH POSTCHOLECYSTECTOMY IATROGENIC BILE DUCT INJURIES: INCIDENCE AND MANAGEMENT IN A HIGH VOLUME CENTER O. Hegazy, H. Soliman, H. Shoreen, S. Saleh, T. Yassin and G. Said National Liver Institute, Egypt Aims: Concomitant vascular injury with post cholecystectomy bile duct injury is possible. It is considered as an increasing finding during repair. Thus, assessment of those injuries is crucial for defining the optimal surgical management. Methods: One hundred and thirty patients were managed surgically for post cholecystectomy bile duct injury between January 2010 and December 2014 in the department of HPB surgery, National Liver Institute, Menoufiya University in Egypt. Patient’s records were revised including preoperative, intraoperative and postoperative data. Follow up visits were also revised. Vascular injury was identified intra-operatively at the beginning of the study while, later, all patients were carried out Computed Topographic hepatic angiography. Results: Twenty eight patients had concomitant vascular injury. Majority were females (75%) with mean age 35years (range, 30e50years). Most of the injuries were post open cholecystectomy (71%). All the patients had right hepatic artery injury while seven had added right portal vein injury. Fifteen patients had right hepatectomy and left hepatico-jejunostomy (53%). Three patients died (11%) due to sepsis and multi-organ failure. The remaining patients had conventional hepatico-jejunostomy. Conclusions: Assessment of vascular injury is an important part in the management of patients with bile duct injuries. Isolated arterial or combined portal injuries may lead to hepatectomy while mortality occurred due to cholangitic abscesses, severe cholangitis with subsequent sepsis.
PANCREATITIS 563 ARE THE CURRENT DIAGNOSTIC CRITERIA FOR ACUTE CHOLANGITIS APPLICABLE IN PATIENTS WITH ACUTE BILIARY PANCREATITIS? N. J. Schepers1,2, O. J. Bakker3, U. A. Ali3, E. J. M. van Geenen4, H. C. van Santvoort5, M. G. Besselink5 and M. J. Bruno1 1 Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam; 2Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein; 3Department of Surgery, University Medical Center Utrecht, Utrecht; 4Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical
Center, Nijmegen; 5Department of Surgery, Academic Medical Center, Amsterdam, Netherlands Aims: In patients with acute biliary pancreatitis and concomitant cholangitis, urgent endoscopic retrograde cholangiography (ERC) is indicated. However, a definition for cholangitis during acute biliary pancreatitis is lacking. The aim of this study was to evaluate the recent Tokyo Guidelines (TG13) for acute cholangitis in patients with acute biliary pancreatitis. Methods: We performed a post hoc analysis of a prospective database of 731 patients with acute pancreatitis included in 15 Dutch hospitals. ERC within 72 h after admission was considered an ‘early ERC’. We evaluated which patients fulfilled the TG13 criteria for acute cholangitis, described the findings during ERC and the clinical outcome. Results: In total 418 out of 731 patients suffered from acute biliary pancreatitis. In the first 72 h of admission, classification according to the TG13 criteria was: 1. no cholangitis (n=147, 35%); 2. suspected cholangitis (n=212, 51%); and 3. definitive cholangitis (n=59, 14%). An ‘early ERC’ was performed in 34 patients (23%) with no cholangitis, 110 patients (52%) with suspected cholangitis, and 54 patients (92%) with definitive cholangitis. Purulent bile was observed during ERC in similar frequency in all 3 groups (3% vs. 9% vs. 11%, P=0.24). Patients with suspected cholangitis in whom an early ERC was performed had similar outcomes compared with patients treated without ERC in terms of mortality (16% vs. 15%, P=0.74), infected pancreatic necrosis (15% vs. 15%, P=0.97), bacteremia (18% vs. 15%, P=0.50) and intensive care unit admission (17% vs. 21%, P=0.54). No significant differences in outcomes were observed between early ERC or conservative treatment in patients with definitive or no cholangitis. Conclusions: Acute cholangitis in the early phase of acute biliary pancreatitis tends to be over-diagnosed when using the TG13 diagnostic criteria potentially leading to unnecessary ERC’s. Accordingly, a more accurate definition is needed for the assessment of acute cholangitis during acute biliary pancreatitis.
BILIARY 0670 POSTOPERATIVE ANTIBIOTIC USE IN THE TREATMENT OF ACUTE CHOLECYSTITIS: A RANDOMIZED MULTICENTRE NONINFERIORITY TRIAL C. S. Loozen1, J. E. Oor1, K. Kortram1, A. W. van Geloven2, P. van Duijvendijk3, G. A. Nieuwegenhuijzen4, S. C. Donkervoort5, A. Gobel1, B. J. Vlaminckx1, C. A. Knibbe1, J. C. Kelder1, V. N. Kornmann1, M. G. Besselink6, B. van Ramshorst1, D. J. Gouma6, H. C. van Santvoort1 and D. Boerma1 1 St Antonius Hospital; 2Tergooi Hospital Hilversum; 3 Gelre Hospitals Apeldoorn; 4Catherina Hospital Eindhoven; 5Onze Lieve Vrouwe Hospital Amsterdam; 6 Academic Medical Centre Amsterdam, Netherlands
HPB 2016, 18 (S2), e854ee856