New model predicts recurrence of acute biliary pancreatitis

Prof. Daniel de la Iglesia-Garcia (University Hospital of Santiago de Compostela, Spain) presented a new scoring model to predict recurrence from a multicentre, retrospective cohort study of patients with a first episode of acute biliary pancreatitis (ABP) [1].

Clinical guidelines for acute pancreatitis (AP) recommend cholecystectomy during the index admission of patients with ABP. This recommendation is not consistently followed, and as a result, the risk of recurrence of ABP is increased. Prof. de la Iglesia-Garcia said that his team aimed to develop a model to determine the risk of recurrence of ABP to prioritise patients on surgical waiting lists. The study made use of a multicentre, retrospective cohort study of patients with a first episode of ABP from January 2010 to December 2015 (n=498). Patients were included upon abdominal ultrasound identification of stones or sludge/microlithiasis in the common bile duct or gallbladder (identified on endoscopic ultrasonography or magnetic resonance cholangiography), together with the absence of AP relapse after cholecystectomy. The primary outcome was the risk of ABP recurrence during the 6-month period after the first episode.

Median time to cholecystectomy was 136 days (range 72-206 days). Patients waiting more than 6 months for cholecystectomy were excluded. A total of 352 patients were finally included (mean age 67.6 years, range 51.6 -77.4; 199 female). ABP relapse occurred in 89 patients (25.3%). Serum alkaline phosphatase at admission, previous endoscopic sphincterotomy, and the severity of the first episode of ABP were all significantly associated with ABP recurrence. The investigators developed a score system (recurrence acute biliary pancreatitis -RABP- score, see Table) based on these measures to categorise patients with ABP into low-, intermediate-, or high-risk groups of recurrence. Assigned scores identified patients with ABP who recurred with a c-statistic of 0.59 (95% CI 0.55-0.64; P<0.01). In the future, this score might be applied to prioritise patients in surgical waiting list for cholecystectomy.

Table. RABP scoring system to stratify patients with acute biliary pancreatitis into low (4 to 8 points), intermediate (9 to 11 points), or high-risk groups (12 to 13 points) [1]

1. De la Iglesia-Garcia D, et al. UEG Week 2019, Abstract OP304

Posted on 23 October 201918 March 2021