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Risk of ERCP related adverse events in patients with primary sclerosing cholangitis: A systematic review and meta-analysis
Abstracts / Pancreatology 15 (2015) S1eS141
patients (13%); bleeding in 3, requiring re-intervention in one patient, and 3 retroperitoneal perforations, all managed conservatively. Conclusion: Contrary to guidelines recommendations, early ERC was performed in one-quarter of patients with predicted mild biliary pancreatitis. Suspected CBDS were the main reason for ERC.
892. Atlanta, revised Atlanta and determinant-based classification? Application in a cohort of portuguese patients with acute pancreatitis Samuel Fernandes, Joana Carvalho, Patrícia Santos, Miguel Moura, Teresa Antunes, Jos e Velosa
S57
6.6%, p¼0.007), ICU admission (43.0% versus 22.6%, p<0.001) and mortality (8.5% versus 2.2%, p¼0.016) were higher in gallstone pancreatitis. There was no difference in the need for interventions or duration of hospitalization. DBC showed higher accuracy in predicting mortality in both alcoholic and gallstone pancreatitis (AUC 0.90 and 0.87, p<0.001), while AT2012 was significant only for gallstone pancreatitis (AUC 0.761 and 0.873, p>0.05 and p<0.001). AT1992 could not predict mortality in either situation. DBC fared better in predicting ICU admission (AUC 0.80 and 0.84 versus 0.76 and 0.77 versus 0.68 and 0.7, p<0.001) and in the need of interventions (0.85 and 0.90 versus 0.73 and 0.76 versus 0.62 and 0.69, p<0.001). Conclusion: Alcoholic and gallstone pancreatitis are separate entities. DBC was superior in all clinical outcomes especially in patients with alcoholic pancreatitis.
Hospital Santa Maria, Serviço Gastrenterologia e Hepatologia, Portugal Introduction: Acute pancreatitis represents a complex and potential fatal disease whose clinical course may be highly variable. Over the years several classification systems have been developed in order to predict severity. These scores have not been previously validated for the Portuguese population. Aims: To evaluate the accuracy of 1992 Atlanta (AT1992), Revised Atlanta (AT2012) and Determinant-based-classification (DBC) scores in predicting severe clinical outcomes in Portuguese patients with acute pancreatitis. Patients & methods: Retrospective study including admissions between January 2003 and September 2014 in a tertiary referral center. Clinical outcomes included mortality, admission to intensive care unit (ICU), need for interventional procedure and total and ICU length of stay. Statistical analysis was performed with STATA v13.0 and SPSS v21.0. Results: 525 patients (59% male) were included. Mean age at admission was 56.4±19.1 years. Most common etiologies included gallstones (38.7%), alcohol (26.1%) and idiopathic (17.9%). During hospitalization 23.0% developed organ failure (in 46.3% persistent) and 5.9% were deceased. In all classification scores higher grades of severity were associated with worse outcomes. Overall, DBC was superior to AT2012 and AT1992 in predicting need for interventions (AUC 0.88 versus 0.78 versus 0.70, p<0.001), admission to ICU (AUC 0.81 versus 0.80 versus 0.75, p<0.001) and mortality (AUC 0.91 versus 0.89 versus 0.69, p<0.001). All scores performed similarly in evaluating total and ICU length of stay. Conclusion: Recent classification scores performed better in all clinical outcomes and showed higher accuracy in predicting severe acute pancreatitis. Our data supports their use for Portuguese patients with acute pancreatitis.
893. Gallstone and alcoholic pancreatitis? Evaluation of Atlanta and determinant based classification scores Samuel Fernandes, Patricia Santos, Joana Carvalho, Miguel Moura, Teresa Antunes, Jos e Velosa Hospital Santa Maria, Serviço de Gastrenterologia e Hepatologia, Portugal Introduction: Gallstones and alcohol represent the most common causes of acute pancreatitis. Classification scores have not been evaluated separately for these two entities. Aims: To evaluate the performance of 1992 Atlanta (AT1992), Revised Atlanta (AT2012) and Determinant-based-classification (DBC) in several outcomes in patients with gallstone and alcoholic pancreatitis. Patients & methods: Retrospective study including admissions between January 2003 and September 2014 in a single tertiary referral center. Demographics, mortality, admission to intensive care unit (ICU) and need for interventional procedures were considered outcomes. Statistical analysis was performed using SPSS v21.0. Results: 358 patients (59.2% male) were included, 59.2% with gallstone pancreatitis. Age at admission was lower in alcoholic pancreatitis (47.1±12.8 versus 72.6±14.1 years, p<0.001). Persistent organ failure (16.5% versus
1150. Risk of ERCP related adverse events in patients with primary sclerosing cholangitis: A systematic review and meta-analysis Rajesh Krishnamoorthi, Karthik Ragunathan, Saurabh Mukewar, Barham Abu Dayyeh Mayo Clinic, United States Introduction: Studies have reported that patients with primary sclerosing cholangitis (PSC) have an increased risk of ERCP related adverse events when compared to Non-PSC patients. Aims: We wanted to estimate the pooled risk of post-ERCP adverse events in PSC patients. Materials & methods: A comprehensive search of several databases from each database’s earliest inception to November 21, 2014, English language, human subjects was conducted. The databases included Ovid MEDLINE, Ovid EMBASE, Ovid Cochrane Database, Scopus, and Web of Science. The search strategy was designed and conducted by an experienced librarian. Controlled vocabulary supplemented with keywords was used to search for studies on post ERCP complications in PSC patients. The cohort studies reporting the incidence of post-ERCP adverse events in PSC patients were identified. The main outcome was risk of post- ERCP adverse event in PSC patients. In addition, sub group analysis was performed to calculate the risk of pancreatitis and cholangitis. Results: According to a meta-analysis of 11 independent cohorts (236 adverse events in 2497 ERCP procedures), the pooled risk of post- ERCP adverse event in PSC patients was 10.3% [95% confidence interval (CI) ¼ 7.6 e 13.9]. The risk of pancreatitis (105 events in in 2497 ERCP procedures) and cholangitis (79 events in in 2497 ERCP procedures) were 4.8% (95% CI ¼ 4 e 5.8) and 3.7% (95% CI ¼ 2.4 e 5.9) respectively. Conclusion: Risk of ERCP related adverse events is high in patients with PSC. Further research is needed to identify the factors that predict ERCP related adverse events in PSC population.
899. The impact of organ failure on mortality in necrotizing pancreatitis Nicolien Schepers 1, Olaf Bakker 2, Marc Besselink 3, Usama Ahmed Ali 2, Thomas Bollen 4, Hein Gooszen 5, Hjalmar van Santvoort 3, Marco Bruno 6 1 Dutch Pancreatitis Study Group, St. Antonius Hospital, Nieuwegein, Netherlands 2 Dept. of Surgery, University Medical Center Utrecht, Utrecht, Netherlands 3 Dept. of Surgery, Academic Medical Center, Amsterdam, Netherlands 4 Dept. of Radiology, St. Antonius Hospital, Nieuwegein, Netherlands 5 Dept. of Operation Rooms and Evidence Based Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands 6 Dept. Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, Netherlands
Introduction: Previous studies suggest that mortality in necrotizing pancreatitis is caused by organ failure or infected pancreatic necrosis.
patients (13%); bleeding in 3, requiring re-intervention in one patient, and 3 retroperitoneal perforations, all managed conservatively. Conclusion: Contrary to guidelines recommendations, early ERC was performed in one-quarter of patients with predicted mild biliary pancreatitis. Suspected CBDS were the main reason for ERC.
892. Atlanta, revised Atlanta and determinant-based classification? Application in a cohort of portuguese patients with acute pancreatitis Samuel Fernandes, Joana Carvalho, Patrícia Santos, Miguel Moura, Teresa Antunes, Jos e Velosa
S57
6.6%, p¼0.007), ICU admission (43.0% versus 22.6%, p<0.001) and mortality (8.5% versus 2.2%, p¼0.016) were higher in gallstone pancreatitis. There was no difference in the need for interventions or duration of hospitalization. DBC showed higher accuracy in predicting mortality in both alcoholic and gallstone pancreatitis (AUC 0.90 and 0.87, p<0.001), while AT2012 was significant only for gallstone pancreatitis (AUC 0.761 and 0.873, p>0.05 and p<0.001). AT1992 could not predict mortality in either situation. DBC fared better in predicting ICU admission (AUC 0.80 and 0.84 versus 0.76 and 0.77 versus 0.68 and 0.7, p<0.001) and in the need of interventions (0.85 and 0.90 versus 0.73 and 0.76 versus 0.62 and 0.69, p<0.001). Conclusion: Alcoholic and gallstone pancreatitis are separate entities. DBC was superior in all clinical outcomes especially in patients with alcoholic pancreatitis.
Hospital Santa Maria, Serviço Gastrenterologia e Hepatologia, Portugal Introduction: Acute pancreatitis represents a complex and potential fatal disease whose clinical course may be highly variable. Over the years several classification systems have been developed in order to predict severity. These scores have not been previously validated for the Portuguese population. Aims: To evaluate the accuracy of 1992 Atlanta (AT1992), Revised Atlanta (AT2012) and Determinant-based-classification (DBC) scores in predicting severe clinical outcomes in Portuguese patients with acute pancreatitis. Patients & methods: Retrospective study including admissions between January 2003 and September 2014 in a tertiary referral center. Clinical outcomes included mortality, admission to intensive care unit (ICU), need for interventional procedure and total and ICU length of stay. Statistical analysis was performed with STATA v13.0 and SPSS v21.0. Results: 525 patients (59% male) were included. Mean age at admission was 56.4±19.1 years. Most common etiologies included gallstones (38.7%), alcohol (26.1%) and idiopathic (17.9%). During hospitalization 23.0% developed organ failure (in 46.3% persistent) and 5.9% were deceased. In all classification scores higher grades of severity were associated with worse outcomes. Overall, DBC was superior to AT2012 and AT1992 in predicting need for interventions (AUC 0.88 versus 0.78 versus 0.70, p<0.001), admission to ICU (AUC 0.81 versus 0.80 versus 0.75, p<0.001) and mortality (AUC 0.91 versus 0.89 versus 0.69, p<0.001). All scores performed similarly in evaluating total and ICU length of stay. Conclusion: Recent classification scores performed better in all clinical outcomes and showed higher accuracy in predicting severe acute pancreatitis. Our data supports their use for Portuguese patients with acute pancreatitis.
893. Gallstone and alcoholic pancreatitis? Evaluation of Atlanta and determinant based classification scores Samuel Fernandes, Patricia Santos, Joana Carvalho, Miguel Moura, Teresa Antunes, Jos e Velosa Hospital Santa Maria, Serviço de Gastrenterologia e Hepatologia, Portugal Introduction: Gallstones and alcohol represent the most common causes of acute pancreatitis. Classification scores have not been evaluated separately for these two entities. Aims: To evaluate the performance of 1992 Atlanta (AT1992), Revised Atlanta (AT2012) and Determinant-based-classification (DBC) in several outcomes in patients with gallstone and alcoholic pancreatitis. Patients & methods: Retrospective study including admissions between January 2003 and September 2014 in a single tertiary referral center. Demographics, mortality, admission to intensive care unit (ICU) and need for interventional procedures were considered outcomes. Statistical analysis was performed using SPSS v21.0. Results: 358 patients (59.2% male) were included, 59.2% with gallstone pancreatitis. Age at admission was lower in alcoholic pancreatitis (47.1±12.8 versus 72.6±14.1 years, p<0.001). Persistent organ failure (16.5% versus
1150. Risk of ERCP related adverse events in patients with primary sclerosing cholangitis: A systematic review and meta-analysis Rajesh Krishnamoorthi, Karthik Ragunathan, Saurabh Mukewar, Barham Abu Dayyeh Mayo Clinic, United States Introduction: Studies have reported that patients with primary sclerosing cholangitis (PSC) have an increased risk of ERCP related adverse events when compared to Non-PSC patients. Aims: We wanted to estimate the pooled risk of post-ERCP adverse events in PSC patients. Materials & methods: A comprehensive search of several databases from each database’s earliest inception to November 21, 2014, English language, human subjects was conducted. The databases included Ovid MEDLINE, Ovid EMBASE, Ovid Cochrane Database, Scopus, and Web of Science. The search strategy was designed and conducted by an experienced librarian. Controlled vocabulary supplemented with keywords was used to search for studies on post ERCP complications in PSC patients. The cohort studies reporting the incidence of post-ERCP adverse events in PSC patients were identified. The main outcome was risk of post- ERCP adverse event in PSC patients. In addition, sub group analysis was performed to calculate the risk of pancreatitis and cholangitis. Results: According to a meta-analysis of 11 independent cohorts (236 adverse events in 2497 ERCP procedures), the pooled risk of post- ERCP adverse event in PSC patients was 10.3% [95% confidence interval (CI) ¼ 7.6 e 13.9]. The risk of pancreatitis (105 events in in 2497 ERCP procedures) and cholangitis (79 events in in 2497 ERCP procedures) were 4.8% (95% CI ¼ 4 e 5.8) and 3.7% (95% CI ¼ 2.4 e 5.9) respectively. Conclusion: Risk of ERCP related adverse events is high in patients with PSC. Further research is needed to identify the factors that predict ERCP related adverse events in PSC population.
899. The impact of organ failure on mortality in necrotizing pancreatitis Nicolien Schepers 1, Olaf Bakker 2, Marc Besselink 3, Usama Ahmed Ali 2, Thomas Bollen 4, Hein Gooszen 5, Hjalmar van Santvoort 3, Marco Bruno 6 1 Dutch Pancreatitis Study Group, St. Antonius Hospital, Nieuwegein, Netherlands 2 Dept. of Surgery, University Medical Center Utrecht, Utrecht, Netherlands 3 Dept. of Surgery, Academic Medical Center, Amsterdam, Netherlands 4 Dept. of Radiology, St. Antonius Hospital, Nieuwegein, Netherlands 5 Dept. of Operation Rooms and Evidence Based Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands 6 Dept. Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, Netherlands
Introduction: Previous studies suggest that mortality in necrotizing pancreatitis is caused by organ failure or infected pancreatic necrosis.