title: [Adherence to the guidelines for treatment of mild biliary acute pancreatitis in the setting of tertiary center in the Czech Republic].
abstract: BACKGROUND
  Cholecystectomy (CCX) represents the crucial procedure in preventing relapses of biliary acute pancreatitis (BAP). Endoscopic papilosphincterotomy (EPST) represent an acceptable alternative in patients unsuitable for surgery. Current guidelines recommend patients with mild BAP to undergo CCX in 2 maximally 4 weeks following discharge from the hospital, ideally during the same hospital stay. Adherence to the guidelines differs significantly between particular countries and institutions.
  
  
  OBJECTIVE
  To evaluate adherence to the guidelines of BAP management in conditions of tertiary hospital in the Czech Republic.
  
  
  METHODS
  Retrospective analysis of consecutive patients hospitalized in the Clinic of Gastroenterology, University Hospital Brno for acute pancreatitis in years 2007-2012. Cases with both sonographic findings of lithiasis/sludge and 3-fold AST/ALT elevation were considered of clearly biliary etiology.
  
  
  RESULTS
  We identified 328 patients treated for acute pancreatitis. Clearly biliary etiology was identified in 116 cases (54 male, 62 female). From 114 analyzed patients with complete documentation 81 underwent CCX, 23 were not operated and 10 cases were patients with history of previous CCX. Total mortality of the group was 5.3%. Out of 81 patients who had CCX was 48 cases of mild BAP. CCX was done during the same hospital stay and/or within 4 weeks from dismissal in 20 patients, therefore, current guidelines were followed in 41.7% of our study group. Eighteen out of the remaining 28 patients underwent ERCP with EPST. Therefore, within 4 weeks from dismissal 75% of our patients underwent a procedure (CCX and/or EPST) with a potential to reduce the risk of BAP recurrence.
  
  
  CONCLUSIONS
  When longer (4 weeks) interval between mild BAP and CCX is applied, the current guidelines are followed in 41.7% of patients treated at our institution, which is comparable with the literature data. As much as 75% of our patients underwent a procedure (CCX and/or EPST) with a potential to reduce the risk of BAP recurrence. However, only 12.5% of index CCX is not favorable outcome that needs improvement. Similar difficulties are being dealt with in the most countries in the World.
authors: Oldřich
authors: O
authors: Stibůrek
authors: Jan
authors: J
authors: Trna
authors: Michal
authors: M
authors: Šenkyřík
authors: Vladimír
authors: V
authors: Procházka
authors: Zdeněk
authors: Z
authors: Kala
authors: Aleš
authors: A
authors: Hep
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019985:Benchmarking; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000706:statistics & numerical data*; D002763:Cholecystectomy / Q000706:statistics & numerical data; D018153:Czech Republic; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000401:mortality / Q000628:therapy*; D017410:Practice Guidelines as Topic; D012008:Recurrence; D012189:Retrospective Studies