Acute pancreatitis in Turkey: Results of a nationwide multicenter study

BACKGROUND

Acute pancreatitis (AP) is the most common gastrointestinal disease requiring hospitalization, with significant mortality and morbidity. We aimed to evaluate the clinical characteristics of AP and physicians' compliance with international guidelines during its management.

METHODS

All patients with AP who were hospitalized at 17 tertiary centers in Turkey between April and October 2022 were evaluated in a prospective cohort study. Patients with insufficient data, COVID-19 and those aged below 18 years were excluded. The definitions were based on the 2012 revised Atlanta criteria.

RESULTS

The study included 2144 patients (median age:58, 52 % female). The most common etiologies were biliary (n = 1438, 67.1 %), idiopathic (n = 259, 12 %), hypertriglyceridemia (n = 128, 6 %) and alcohol (n = 90, 4.2 %). Disease severity was mild in 1567 (73.1 %), moderate in 521 (24.3 %), and severe in 58 (2.6 %) patients. Morphology was necrotizing in 4.7 % of the patients. The overall mortality rate was 1.6 %. PASS and BISAP had the highest accuracy in predicting severe pancreatitis on admission (AUC:0.85 and 0.81, respectively). CT was performed in 61 % of the patients, with the majority (90 %) being within 72 h after admission. Prophylactic NSAIDs were not administered in 44 % of the patients with post-ERCP pancreatitis (n = 86). Antibiotics were administered to 53.7 % of the patients, and 38 % of those received them prophylactically.

CONCLUSIONS

This prospective study provides an extensive report on clinical characteristics, management and outcomes of AP in real-world practice. Mortality remains high in severe cases and physicians' adherence to guidelines during management of the disease needs improvement in some aspects.

Evaluation of Development of Nonalcoholic Fatty Pancreas Disease After Post-Endoscopic Retrograde Cholangiop ancreatography Pancreatitis in Liver Transplant Patients: Computerized Tomography Versus Ultrasound

BACKGROUND/AIMS

Post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) is the most common serious adverse event in liver transplant patients The average incidence has been reported as 1.3%-15.1% in prospective series. In our study, we have prospectively evaluated the prevalence of nonalcoholic fatty pancreatic disease (NAFPD) after PEP via computerized tomography (CT) and determined the ratio of fatty pancreas by ultrasound imaging in liver transplant patients.

MATERIALS AND METHODS

We have retrospectively analyzed 2922 patient files, and 146 patients were indicated for ERCP. PEP was observed in 32 patients. After presenting the significant association between the NAFPD and PEP, we prospectively reached 32 patients included in the study. Ten out of those patients have been performed ultrasound with regard to NAFPD.

RESULTS

PEP was defined in 32 patients in whom CT was performed to investigate NAFPD. When the patients were contacted, it was observed that 12% were deceased, 71% were alive, but 15% of them were untraceable. Ultrasound has been performed on 10 of 32 patients to determine NAFPD. There was a significant reduction in post-PEP pancreas/spleen rate compared to pre-PEP pancreas/ spleen rate (P = .001). Both the pre-PEP and post-PEP pancreas-spleen difference dropped significantly (P = .002).

CONCLUSION

Ultrasound imaging could be utilized as a scanning test and an alternative to evaluate and diagnose NAFPD, particularly in risky patients.

Liver injury after SARS-CoV-2 vaccination: Features of immune-mediated hepatitis, role of corticosteroid therapy and outcome

BACKGROUND AND AIMS

A few case reports of autoimmune hepatitis-like liver injury have been reported after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. We evaluated clinical features, treatment response and outcomes of liver injury following SARS-CoV-2 vaccination in a large case series.

APPROACH AND RESULTS

We collected data from cases in 18 countries. The type of liver injury was assessed with the R-value. The study population was categorized according to features of immune-mediated hepatitis (positive autoantibodies and elevated immunoglobulin G levels) and corticosteroid therapy for the liver injury. We identified 87 patients (63%, female), median age 48 (range: 18-79) years at presentation. Liver injury was diagnosed a median 15 (range: 3-65) days after vaccination. Fifty-one cases (59%) were attributed to the Pfizer-BioNTech (BNT162b2) vaccine, 20 (23%) cases to the Oxford-AstraZeneca (ChAdOX1 nCoV-19) vaccine and 16 (18%) cases to the Moderna (mRNA-1273) vaccine. The liver injury was predominantly hepatocellular (84%) and 57% of patients showed features of immune-mediated hepatitis. Corticosteroids were given to 46 (53%) patients, more often for grade 3-4 liver injury than for grade 1-2 liver injury (88.9% vs. 43.5%, p = 0.001) and more often for patients with than without immune-mediated hepatitis (71.1% vs. 38.2%, p = 0.003). All patients showed resolution of liver injury except for one man (1.1%) who developed liver failure and underwent liver transplantation. Steroid therapy was withdrawn during the observation period in 12 (26%) patients after complete biochemical resolution. None had a relapse during follow-up.

CONCLUSIONS

SARS-CoV-2 vaccination can be associated with liver injury. Corticosteroid therapy may be beneficial in those with immune-mediated features or severe hepatitis. Outcome was generally favorable, but vaccine-associated liver injury led to fulminant liver failure in one patient.

Optimal Endoscopic Management of Anastomotic Strictures After Double- Biliary Reconstruction in Right Lobe Living-Donor Liver Transplantation

Background

There is no consensus on the optimal drainage technique in the management of biliary anastomotic strictures occurring after right-lobe living-donor liver transplantation (RL LDLT).

Aims

To investigate whether there is a superiority between unilateral and bilateral drainage groups in terms of efficacy and safety of biliary drainage in RL LDLT patients undergoing double-biliary reconstruction.

Study Design

Retrospective Cohort

Methods

Between January 2009 and August 2019, 1693 patients underwent RL LDLT. Of these, 182 patients who developed biliary anastomotic strictures out of the 306 patients who had double-biliary reconstruction, were included in the study. One hundred fifty-five patients with technical success were divided into 2 groups as unilateral (n=116) and bilateral (n=39) drainage groups. The groups were compared in terms of variable parameters such as clinical success, additional procedure, post-ERCP complication, procedures after clinical failure, hospital stay, mortality, and survival.

Results

The clinical success was higher in the bilateral group (70% vs. 82%, P = .201). In the initial and the follow-up periods, a total of 44 (38%) patients in the unilateral group were switched to the bilateral drainage group due to the increased need for stenting. The placement of a stent successfully solved the problem only in 28% (32/117) of the patients in the unilateral group, while this rate was 44% (17/39) in the bilateral group. The median follow-up time of both groups was 42 months, and was equal. The number of stent-free follow-up patients in the unilateral drainage group was less than that in the bilateral drainage group (4 and 7, respectively).

Conclusion

An active attempt should be made for bilateral drainage in patients with biliary anastomotic stricture following RL LDLT. However, for patients in whom bilateral drainage is not possible, unilateral drainage may be recommended, with the placement of a maximum number of stents following primary biliary balloon dilatation, depending on the degree of stricture.

Endoscopic treatment of biliary complications in donors after living donor liver transplantation in a high volume transplant center

BACKGROUND/AIMS

Although living donor liver transplantation (LDLT) has been accepted as a primary treatment for adults with end-stage liver disease, concerns about donor health have been emerged. As LDLT is technically complex, it creates perioperative morbidity and mortality risk in donors. Biliary complications such as stricture and leakage are seen most frequently in donors after liver transplantation. While some of these complications get treated with conservative approach, endoscopic, surgical, and percutaneous interventions may be required in some others. We aimed to present endoscopic retrograde cholangiography (ERC) results in donors who developed biliary complications after LDLT.

MATERIALS AND METHODS

Between June 2010 and January 2018, a total of 1521 donors (1291 right lobe grafts, 230 left lobe grafts) of patients who underwent LDLT, were retrospectively reviewed. 63 donors who underwent ERC due to biliary complication, were included in the study.

RESULTS

Biliary stricture was found in 1.6% (25/1521), biliary leakage in 2.1% (33/1521), and stricture and leakage together in 0.3% (5/1521) donors. Our endoscopic success rates in patients with biliary leakage, biliary stricture, and stricture and leakage were 85% (28/33), 92% (23/25), and 80% (4/5), respectively. Surgical treatment was performed on 12.6% (8/63) donors who failed ERC.

CONCLUSION

We found that ERC is a successful treatment for post-LDLT donors who have biliary complications.

An obstruction not to forget: Pseudo-obstruction (Ogilvie syndrome): Single center experience

Purpose:

Colonic pseudo obstruction disease commonly seen in the elderly, immobile patient group can cause serious mortality and morbidity. Our objective in this retrospective study is to share our clinical experience by evaluating patients with Ogilvie syndrome who were followed and treated in our clinic.

Methods:

Eleven cases with the diagnosis of Ogilvie syndrome followed up and treated between September 2010 and April 2013 were evaluated retrospectively. All the patients that had no symptoms of acute abdominal pain were initiated conservative treatment. Colonoscopic decompression was attempted for patients whose clinical pictures were not recovered. Patients underwent operation if they developed peritoneal irritation symptoms during these procedures and of their number of white blood cells seriously increased during the follow-up period.

Results:

A total of 11 patients were treated for Ogilvie syndrome. 6 of the patients underwent surgical treatment, and 5 were treated medically. Mortality developed in two patients. The main cause of mortality was a delay in diagnosis and additional severe underlying diseases. Seven patients were given Neostigmine. Of these, 2 patients required surgery and 3 patients responded to Neostigmine.

Conclusion:

Ogilvie syndrome is a rare cause of ileus of the colon. It is more common particularly in old patients with additional problems. If the disease is suspected and diagnosed early, unnecessary surgical interventions can be prevented with medical treatment choices.