Management guidelines for gallstone pancreatitis. Are the targets achievable?
BACKGROUND
Current management of gallstone pancreatitis in a university hospital.


OBJECTIVE
Comparison of current management of gallstone pancreatitis with recommendations in national guidelines.


METHODS
Tertiary care centre in Scotland.


METHODS
One-hundred consecutive patients admitted with gallstone pancreatitis.


METHODS
All patients that presented with gallstone pancreatitis over a 4-year period were audited retrospectively. Data were collated for radiological diagnosis within 48 hours, ERCP within 72 hours, CT at 6-10 days, and use of high-dependency or intensive therapy units in severe gallstone pancreatitis, and definitive treatment of gallstone pancreatitis within 2 weeks as recommended in national guidelines.


RESULTS
Forty-six patients had severe gallstone pancreatitis and 54 patients mild pancreatitis. Etiology was established within 48 hours in 92 patients. Six (13.0%) out of the patients with severe gallstone pancreatitis were managed in a high dependency unit. Fifteen (32.6%) patients with severe gallstone pancreatitis underwent CT within 6-10 days of admission. Four (8.7%) of the 46 patients with severe gallstone pancreatitis had urgent ERCP (less than 72 hours). Overall 22/100 patients unsuitable for surgery underwent endoscopic sphincterotomy as definitive treatment. Seventy-eight patients had surgery, with 40 (51.3%) of these patients undergoing an index admission cholecystectomy, and 38 (48.7%) patients were discharged for interval cholecystectomy. Overall 81 patients with gallstone pancreatitis had definitive therapy during the index to same admission (cholecystectomy or sphincterotomy). Two (5.3%) patients were readmitted whilst awaiting interval cholecystectomy: one with acute cholecystitis and one with acute pancreatitis. There were no mortalities in this cohort.


CONCLUSIONS
This study has highlighted difficulties in implementation of national guidelines, as the use of critical care, timing of ERCP and CT, and definitive treatment prior to discharge did not concur with national targets for gallstone pancreatitis.
Sanjay
Pandanaboyana
P
Department of Hepatobiliary and Pancreatic Surgery, Ninewells Hospital and Medical School, Dundee, Scotland, United Kingdom. sanjay.pandanaboyana@nhs.net
Yeeting
Sim
S
Whigham
Carole
C
Judson
Hannah K
HK
Kulli
Christoph
C
Polignano
Francesco M
FM
Tait
Iain S
IS
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002763:Cholecystectomy / Q000706:statistics & numerical data; D005260:Female; D042882:Gallstones / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy*; D019983:Guideline Adherence / Q000706:statistics & numerical data; D017408:Guidelines as Topic; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy*; D010343:Patient Admission / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016717:Sphincterotomy, Endoscopic / Q000706:statistics & numerical data; D014463:Ultrasonography; D055815:Young Adult