Objective: To evaluate the management of acute biliary pancreatitis (ABP) at the Fran？ois Quesnay Hospital Center (FQHC) of Mantes-la-Jolie. Patients and methods: This was an observational, analytical, cross-sectional study with retrospective data collection, conducted from January 2019 to September 2024 at the FQHC. All patients over 18 years of age hospitalized in the gastroenterology department for ABP were included. Severity was assessed using SIRS, CRP at 48 hours, the CT severity index (CTSI), and the Atlanta score at 96 hours. Outcomes were analyzed following nutritional, endoscopic, and surgical management (cholecystectomy). Results: Ninety-eight patients were included, corresponding to a hospital frequency of 3.18%. ABP was mild to moderately severe in 87.7% of cases and severe in 12.2%. Cholecystectomy was delayed in 62.2% of patients for organizational reasons. Endoscopic sphincterotomy was performed in 28.6% of patients, with biliary stent placement in 5 cases. Enteral nutrition was initiated in 69.2% of severe forms. Complications occurred in 15.3% of patients, 53.3% of whom had severe ABP; recurrences were more frequent in moderately severe forms. Moderately severe ABP and biliary stent placement were independently associated with the occurrence of a biliary event. Conclusion: ABP remains an emergency regardless of its degree of severity. Delays in implementing management guidelines may explain the non-negligible proportion of biliary events observed.
References
[1]
Windisch, O., Raffoul, T., Hansen, C., Frossard, J., Morel, P. and Bühler, L. (2017) Pancréatite aigu？: Quelles nouveautés dans la prise en charge? RevueMédicaleSuisse, 13, 1240-1246. https://doi.org/10.53738/revmed.2017.13.567.1240
[2]
Krishna, S.G., Kamboj, A.K., Hart, P.A., Hinton, A. and Conwell, D.L. (2017) The Changing Epidemiology of Acute Pancreatitis Hospitalizations: A Decade of Trends and the Impact of Chronic Pancreatitis. Pancreas, 46, 482-488. https://doi.org/10.1097/mpa.0000000000000783
[3]
Vos, T., Barber, R.M., Bell, B., Bertozzi-Villa, A., Biryukov, S., Bolliger, I., et al. (2015) Global, Regional, and National Incidence, Prevalence, and Years Lived with Disability for 301 Acute and Chronic Diseases and Injuries in 188 Countries, 1990-2013: A Systematic Analysis for the Global Burden of Disease Study 2013. TheLancet, 386, 743-800. https://doi.org/10.1016/s0140-6736(15)60692-4
[4]
Buscail, L. (2016) Acute Pancreatitis. FMC-HE. POST-U, 193-197.
[5]
Working Group IAP/APA Acute Pancreatitis (2013) IAP/APA Evidence-Based Guidelines for the Management of Acute Pancreatitis. Pancreatology, 13, e1-e15.
[6]
Lévy, P. (2015) Recommandations internationales sur la pancréatite aigu？. Société nationale fran？aise de gastroentérologie; POST’U, 19-25.
[7]
Rebours, V. (2024) Pancréatite aigu？: Prise en charge à la phase initiale. Formation Médicale Continue en Hépato-Gastro-Entérologie, POST-U, 353-357.
[8]
Roberts, S.E., Morrison-Rees, S., John, A., Williams, J.G., Brown, T.H. and Samuel, D.G. (2017) The Incidence and Aetiology of Acute Pancreatitis across Europe. Pancreatology, 17, 155-165. https://doi.org/10.1016/j.pan.2017.01.005
[9]
Banks, P.A., Bollen, T.L., Dervenis, C., Gooszen, H.G., Johnson, C.D., Sarr, M.G., et al. (2013) Classification of Acute Pancreatitis—2012: Revision of the Atlanta Classification and Definitions by International Consensus. Gut, 62, 102-111. https://doi.org/10.1136/gutjnl-2012-302779
[10]
Papachristou, G.I., Muddana, V., Yadav, D., O’Connell, M., Sanders, M.K., Slivka, A., et al. (2010) Comparison of BISAP, Ranson’s, APACHE-II, and CTSI Scores in Predicting Organ Failure, Complications, and Mortality in Acute Pancreatitis. AmericanJournalofGastroenterology, 105, 435-441. https://doi.org/10.1038/ajg.2009.622
[11]
Taieb, M., Khiali, R., Ammari, S., Slimane, N., Tibiche, A., Hammad, A., et al. (2019) Résultats de la prise en charge de 271 pancréatites aigues sévères. e-Mémoires de l’Académie nationale de chirurgie, 18, 2.
[12]
Slimane, N., Khiali, R. and Mustapha, T. (2020) épidémiologie des pancréatites aigu？s. Annales Algériennes de Chirurgie？, 51, 22-29.
[13]
Hirota, M., Sugita, H., Maeda, K., Ichibara, A. and Ogawa, M. (2004) SIRS Concept and Severe Acute Pancreatitis. Nihon Rinsho, 62, 2128-2136.
[14]
Moryoussef, F., Grasset, D., Remy, A.D., Bellon, S., Mayer, P., Vidon, M., et al. (2024) Premier résultat de la cohorte CAPABLES-Cohorte ANGH des pancréatites aigues biliaires légères et sévères. Post’U.
[15]
Lepp？niemi, A., Tolonen, M., Tarasconi, A., Segovia-Lohse, H., Gamberini, E., Kirkpatrick, A.W., et al. (2019) 2019 WSES Guidelines for the Management of Severe Acute Pancreatitis. WorldJournalofEmergencySurgery, 14, Article No. 27. https://doi.org/10.1186/s13017-019-0247-0
[16]
Sun, J.K., Mu, X.W., Li, W.Q., Tong, Z.H., Li, J. and Zheng, S.Y. (2013) Effects of Early Enteral Nutrition on Immune Function of Severe Acute Pancreatitis Patients. WorldJournalofGastroenterology, 19, 917-922. https://doi.org/10.3748/wjg.v19.i6.917
[17]
Zerhouni, A., Belhaj, A., Toughrai, I., Mazaz, K. and Ibn Majdoub, K. (2024) Acute Pancreatitis, Severity Scores and Management According to the New Recommendations: Moroccan Series of 356 Cases. Cahiers Santé Médecine Thérapeutique, 33, 92-97. https://doi.org/10.1684/sanmt.2024.251
[18]
Benmansour, S. (2022) Pancréatite aigu？ lithiasique au Centre Hospitalo-universitaire de Tlemcen. Thèse de doctorat en Médecine, Annales universitaire d’Algérie.
[19]
Yasui, T., Takahata, S., Kono, H., Nagayoshi, Y., Mori, Y., Tsutsumi, K., et al. (2012) Is Cholecystectomy Necessary after Endoscopic Treatment of Bile Duct Stones in Patients Older than 80 Years of Age? JournalofGastroenterology, 47, 65-70. https://doi.org/10.1007/s00535-011-0461-3
[20]
Sinha, R. (2008) Early Laparoscopic Cholecystectomy in Acute Biliary Pancreatitis: The Optimal Choice? HPB (Oxford), 10, 332-335. https://doi.org/10.1080/13651820802247078
