Survey on initial management of acute pancreatitis in Latin America / Encuesta sobre el manejo inicial de la pancreatitis aguda en América Latina

Objective: The population of Latin America harbors the highest incidence of gallstones and acute biliary pancreatitis, yet little is known about the initial management of acute pancreatitis in this large geographic region. Participants and methods: We performed a post hoc analysis of responses from physicians based in Latin America to the international multidisciplinary survey on the initial management of acute pancreatitis. The questionnaire asked about management of patients during the first 72h after admission, related to fluid therapy, prescription of prophylactic antibiotics, feeding and nutrition, and timing of cholecystectomy. Adherence to clinical guidelines in this region was compared with the rest of the world. Results: The survey was completed by 358 participants from 19 Latin American countries (median age, 39 years [33–47]; women, 27.1%). The proportion of participants in Latin America vs. the rest of the world who chose non-compliant options with clinical guidelines were: prescription of fluid therapy rate other than moderate (42.2% vs 34.3%, P=.02); prescription of prophylactic antibiotics for severe (10.6% vs 18.0%, P=.002), necrotizing (28.5% vs 36.9%, P=.008), or systemic inflammatory response syndrome-associated (21.2% vs 30.6%, P=.002) acute pancreatitis; not starting an oral diet to patients with oral tolerance (77.9% vs 71.1%, P=.02); and delayed cholecystectomy (16.2% vs 33.8%, P<.001). Conclusions: Surveyed physicians in Latin America are less likely to prescribe antibiotics and to delay cholecystectomy when managing patients in the initial phase of acute pancreatitis compared to physicians in the rest of the world. Feeding and nutrition appear to require the greatest improvement. (AU)

Objetivo: La población de América Latina alberga la mayor incidencia de cálculos biliares y pancreatitis biliar aguda, sin embargo, poco se sabe sobre el manejo inicial de la pancreatitis aguda en esta extensa región geográfica. Participantes y métodos: Se realizó un análisis post hoc de las respuestas de los médicos de América Latina a la encuesta internacional multidisciplinar sobre el tratamiento inicial de la pancreatitis aguda. En el cuestionario se preguntaba por el manejo de los pacientes durante las primeras 72 h tras el ingreso, en relación con la fluidoterapia, la prescripción de antibióticos profilácticos, la alimentación y nutrición y el momento de la colecistectomía. La adherencia a las guías clínicas en esta región se comparó con la del resto del mundo. Resultados: La encuesta fue completada por 358 participantes de 19 países latinoamericanos (mediana de edad, 39 años [33-47]; mujeres, 27,1%). La proporción de participantes de América Latina frente al resto del mundo que eligieron opciones no conformes con las guías clínicas fueron: prescripción de fluidoterapia en casos distintos de los moderados (42,2 vs. 34,3%, p = 0,02); prescripción de antibióticos profilácticos en casos graves (10,6 vs. 18%, p = 0,002); necrotizante (28,5 vs. 36,9%, p = 0,008) o asociada al síndrome de respuesta inflamatoria sistémica (21,2 vs. 30,6%, p = 0,002); no inicio de dieta oral en pacientes con tolerancia oral (77,9 vs. 71,1%, p = 0,02); y retraso de la colecistectomía (16,2 vs. 33,8%, p < 0,001). Conclusiones: Los médicos encuestados en América Latina son menos propensos a prescribir antibióticos y a retrasar la colecistectomía cuando tratan a pacientes en la fase inicial de la pancreatitis aguda, en comparación con los médicos del resto del mundo. La alimentación y la nutrición parecen requerir las mayores mejoras. (AU)

Survey on initial management of acute pancreatitis in Latin America.

OBJECTIVE: The population of Latin America harbors the highest incidence of gallstones and acute biliary pancreatitis, yet little is known about the initial management of acute pancreatitis in this large geographic region. PARTICIPANTS AND METHODS: We performed a post hoc analysis of responses from physicians based in Latin America to the international multidisciplinary survey on the initial management of acute pancreatitis. The questionnaire asked about management of patients during the first 72h after admission, related to fluid therapy, prescription of prophylactic antibiotics, feeding and nutrition, and timing of cholecystectomy. Adherence to clinical guidelines in this region was compared with the rest of the world. RESULTS: The survey was completed by 358 participants from 19 Latin American countries (median age, 39 years [33-47]; women, 27.1%). The proportion of participants in Latin America vs. the rest of the world who chose non-compliant options with clinical guidelines were: prescription of fluid therapy rate other than moderate (42.2% vs 34.3%, P=.02); prescription of prophylactic antibiotics for severe (10.6% vs 18.0%, P=.002), necrotizing (28.5% vs 36.9%, P=.008), or systemic inflammatory response syndrome-associated (21.2% vs 30.6%, P=.002) acute pancreatitis; not starting an oral diet to patients with oral tolerance (77.9% vs 71.1%, P=.02); and delayed cholecystectomy (16.2% vs 33.8%, P<.001). CONCLUSIONS: Surveyed physicians in Latin America are less likely to prescribe antibiotics and to delay cholecystectomy when managing patients in the initial phase of acute pancreatitis compared to physicians in the rest of the world. Feeding and nutrition appear to require the greatest improvement.

Pancreatitis recurrente en pediatría: serie de casos / Recurrent pancreatitis in children: Case series

La pancreatitis recurrente (PR) ocurre en el 15-36 % de las pancreatitis agudas, en la edad pediátrica. Se realizó un estudio descriptivo y transversal, para determinar la etiología y la evolución en menores de 18 años con diagnóstico de PR entre 2008-2016 en el Hospital Garrahan. Se incluyeron 10 pacientes, el 90 % de sexo femenino. La mediana de edad fue de 11 años. La mediana del número de episodios fue de nueve. La ecografía abdominal y/o la colangioresonancia iniciales mostraron hallazgos patológicos en cuatro pacientes. De los seis pacientes con estudios iniciales normales, tres desarrollaron signos de pancreatitis crónica (PC), uno con estenosis del Wirsung sugestiva de pancreatitis autoinmune. El 40 % de los pacientes tuvo diagnóstico etiológico. En el seguimiento, tres pacientes con pancreatitis idiopática desarrollaron PC. Los factores genéticos podrían jugar un papel en los casos considerados idiopáticos.

Recurrent pancreatitis (RP) occurs in children between 15-35 % of the cases. To determine the etiology and outcome of RP in children a descriptive, cross-sectional cohort study was conducted in children under 18 years of age with RP seen at Hospital Garrahan between 2008-2016. Of 10 patients with RP, 90 % were girls. Median age of the diagnoses of RP was 11. Median number of episodes was 9. Initial abdominal ultrasonography and/or magnetic resonance cholangiopancreatography were abnormal in four patients. Of six patients with normal studies at onset, three developed signs of chronic pancreatitis (CP) and one stenosis of the duct of Wirsung suggestive of autoimmune pancreatitis. In 40 % of our patients, the etiology was determined. On follow-up, three patients with idiopathic pancreatitis developed CP. Genetic factors may play a role in patients considered to have idiopathic pancreatitis.

[Recurrent pancreatitis in children: Case series]. / Pancreatitis recurrente en pediatría: serie de casos.

Recurrent pancreatitis (RP) occurs in children between 15- 35 % of the cases. To determine the etiology and outcome of RP in children a descriptive, cross-sectional cohort study was conducted in children under 18 years of age with RP seen at Hospital Garrahan between 2008-2016. Of 10 patients with RP, 90 % were girls. Median age of the diagnoses of RP was 11. Median number of episodes was 9. Initial abdominal ultrasonography and/or magnetic resonance cholangiopancreatography were abnormal in four patients. Of six patients with normal studies at onset, three developed signs of chronic pancreatitis (CP) and one stenosis of the duct of Wirsung suggestive of autoimmune pancreatitis. In 40 % of our patients, the etiology was determined. On follow-up, three patients with idiopathic pancreatitis developed CP. Genetic factors may play a role in patients considered to have idiopathic pancreatitis.

La pancreatitis recurrente (PR) ocurre en el 15-36 % de las pancreatitis agudas, en la edad pediátrica. Se realizó un estudio descriptivo y transversal, para determinar la etiología y la evolución en menores de 18 años con diagnóstico de PR entre 2008-2016 en el Hospital Garrahan. Se incluyeron 10 pacientes, el 90 % de sexo femenino. La mediana de edad fue de 11 años. La mediana del número de episodios fue de nueve. La ecografía abdominal y/o la colangioresonancia iniciales mostraron hallazgos patológicos en cuatro pacientes. De los seis pacientes con estudios iniciales normales, tres desarrollaron signos de pancreatitis crónica (PC), uno con estenosis del Wirsung sugestiva de pancreatitis autoinmune. El 40 % de los pacientes tuvo diagnóstico etiológico. En el seguimiento, tres pacientes con pancreatitis idiopática desarrollaron PC. Los factores genéticos podrían jugar un papel en los casos considerados idiopáticos.

Diagnóstico y tratamiento de la pancreatitis aguda en la Argentina. Resultados de un estudio prospectivo en 23 centros.

In Argentina there are no multicenter studies evaluating the management of patients with acute pancreatitis (AP) nationwide. OBJECTIVES: The main objective of this study is to know how the patients with AP are treated in Argentina. The secondary objective is to assess whether the results comply with the recommendation of the American College of Gastroenterology Guide. MATERIAL AND METHODS: Twenty three center participated in the study. They include in a database hosted online consecutive patients with acute pancreatitis from june 2010 to june 2013. RESULTS: 854 patients entered the study. The average age was 46.6 years and 495 (58%) belonged to the female sex. The most common cause (88.2%) of AP was biliary. Some prognostic system was used in 99 % of patients and the most used was Ranson (74.5%). Were classified as mild 714 (83.6%) patients and severe 140 (16.4%). Systemic complications occurred in 43 patients and local complications in 21. 86 patients underwent dynamic CT scans and 73 patients had pancreatic and / or peripancreatic necrosis. Mortality was 1.5%. There was no difference in mortality in relation to the size, complexity or affiliation of the center. The comply of key recommendations of the American College of Gastroenterology Guide was over 80%. CONCLUSIONS: The diagnosis and treatment of patients with AP in 23 health centers located throughout the country was optimal. The management complied with most of the recommendations of the American College of Gastroenterology Guide.

Diagnóstico y tratamiento de la pancreatitis aguda en la Argentina. Resultados de un estudio prospectivo en 23 centros.

In Argentina there are no multicenter studies evaluating the management of patients with acute pancreatitis (AP) nationwide. OBJECTIVES: The main objective of this study is to know how the patients with AP are treated in Argentina. The secondary objective is to assess whether the results comply with the recommendation of the American College of Gastroenterology Guide. MATERIAL AND METHODS: Twenty three center participated in the study. They include in a database hosted online consecutive patients with acute pancreatitis from june 2010 to june 2013. RESULTS: 854 patients entered the study. The average age was 46.6 years and 495 (58%) belonged to the female sex. The most common cause (88.2%) of AP was biliary. Some prognostic system was used in 99 % of patients and the most used was Ranson (74.5%). Were classified as mild 714 (83.6%) patients and severe 140 (16.4%). Systemic complications occurred in 43 patients and local complications in 21. 86 patients underwent dynamic CT scans and 73 patients had pancreatic and / or peripancreatic necrosis. Mortality was 1.5%. There was no difference in mortality in relation to the size, complexity or affiliation of the center. The comply of key recommendations of the American College of Gastroenterology Guide was over 80%. CONCLUSIONS: The diagnosis and treatment of patients with AP in 23 health centers located throughout the country was optimal. The management complied with most of the recommendations of the American College of Gastroenterology Guide.