The Use of Prophylaxis Antibiotics to Prevent Acute Pancreatitis Complications: Meta-Analysis of Clinical Trials

Background: Acute pancreatitis (AP) is an inflammation of the pancreas, a serious emergency with no definitive treatment. It may progress to infected necrosis, non-pancreatitis infection, also death that may occur within the first 1 to 2 weeks. The use of prophylactic antibiotics in AP to prevent complications remains a controversy. The objective of this meta-analysis is to assess the benefit of prophylaxis antibiotics administration to prevent the complication.Method: Trials were identified by searching the medical database. Literature range is within the year 1975 to 2021. Review Manager 5.4.1 was used to analyse data extraction and risk of bias of included studies were elaborated. Risk ratio (RR) was calculated with 95% confidence interval (CI). P 0.05 was considered significant.Results: Twenty trials with a total of 1.287 patients of AP were analysed; 646 patients treated with antibiotic prophylaxis and 641 patients treated with placebo. Prophylaxis antibiotics were found to have significant difference between the two groups. The administration of prophylaxis antibiotics lower the risk of non-pancreatic infections (RR = 0.77; 95% CI: 0.62–0.95; p 0.05) and infected pancreatic necrosis (RR = 0.74; 95% CI: 0.58-0.94; p 0.05). Meanwhile, prophylaxis antibiotics were found to be insignificant to lower the risk of mortality (RR = 0.75; 95% CI: 0.54-1.03; p 0.05). Conclusion: Prophylaxis antibiotics lower the risk of non-pancreatic infections and infected pancreatic necrosis, but did not lower the risk of mortality.

Spontaneous drainage of the pseudocyst of the tail of the pancreas with the formation of a junction between the cyst and the stomach

The aim of the study was to evaluate the informative value of various diagnostic methods for spontaneous drainage of the pancreatic pseudocyst into the stomach.Materials and methods: based on the clinical observation of a patient who received complaints of pain in the epigastrium, an episode of melena, after suffering acute pancreatitis several years ago with the development of pancreatic necrosis with an outcome in the cyst of the tail of the pancreas, drainage of the omentum bag. The patient underwent a comprehensive laboratory and instrumental examination.Results: ultrasound, endoscopic examination, MSCT suspected a malignant process in the stomach with ulceration and germination into the pancreas. After performing endoscopic ultrasonography, it was possible to differentiate the layers of the formation and make the correct diagnosis, which was confirmed by subsequent MSCT with oral contrast.Conclusions: a spontaneously opened pancreatic pseudocyst in the lumen of the stomach is a rare and difficult to diagnose disease. An integrated approach, including endoscopic, ultrasound, X-ray, and laboratory methods of investigation when compared with the clinical picture, allows us to verify the formation of the pancreas.

Evaluation of the Antiviral Activity against Infectious Pancreatic Necrosis Virus (IPNV) of a Copper (I) Homoleptic Complex with a Coumarin as Ligand

The aquatic infectious pancreatic necrosis virus (IPNV) causes a severe disease in farmed salmonid fish that generates great economic losses in the aquaculture industry. In the search for new tools to control the disease, in this paper we show the results obtained from the evaluation of the antiviral effect of [Cu(NN1)2](ClO4) Cu(I) complex, synthesized in our laboratory, where the NN1 ligand is a synthetic derivate of the natural compound coumarin. This complex demonstrated antiviral activity against IPNV at 5.0 and 15.0 µg/mL causing a decrease viral load 99.0% and 99.5%, respectively. The Molecular Docking studies carried out showed that the copper complex would interact with the VP2 protein, specifically in the S domain, altering the process of entry of the virus into the host cell.

P-P31 Splanchnic vein thrombosis in acute pancreatitis: Incidence, risk factors and long term outcomes

Background There is paucity of data on the incidence, risk factors and role of anticoagulation for splanchnic vein thrombosis (SVT) in acute pancreatitis (AP). Methods A retrospective review of AP admissions between 2018-2021 across North East England was undertaken. Data on demographics, etiology, severity of AP and SVT was collected. In addition, a selective anticoagulation policy for portal vein thrombosis (PVT) and progressive splenic vein thrombosis was explored. Results 401 patients were included with a mean age of 57.0 and M:F ratio of 1.6:1. 152 patients developed intestinal oedematous pancreatitis and 249 developed necrotising pancreatitis based on Revised Atlanta criteria (RAC). 109 patients (27.2%) developed SVT of which 27 developed a PVT and splenic vein thrombus, 36 PVT only and 46 splenic vein thrombus only. On univariate analysis, alcoholic aetiology, severe pancreatitis, necrotising pancreatitis with >50% necrosis and elevated CRP at 2 weeks were risk factors for developing SVT. On multivariable analysis, alcohol aetiology (OR 2.6, p = 0.002), and >50% pancreatic necrosis (OR 14.6,p = 0.048) increased the risk of developing SVT . 58 patients received anticoagulation for SVT, with a median duration of 90 days of anticoagulation. Recanalization rates were higher for PVT when compared to splenic vein thrombosis. 6 patients developing bleeding complications whilst on anticoagulation therapy. Conclusions A third of patients with AP develop SVT, particularly those with severe AP secondary to alcohol and with extensive pancreatic necrosis. A selective anticoagulation policy was associated with improved recanalization rates and fewer bleeding complications.

O-BN05 The management of pancreatitis and complications that require intervention in a Benign Specialist Surgical Unit

Background Acute pancreatitis or inflammation of the pancreas is a common surgical pathology that presents with a spectrum of severity. The condition itself ranges from a mild/moderate self-limiting pathology to one associated with a systemic inflammatory response that can lead to organ dysfunction and death. We aim to investigate the aetiology/management and outcomes of patients presenting with pancreatitis in a benign specialist surgical unit with dedicated upper GI surgical care. Methods A retrospective analysis of all patients presenting and falling under surgical care with biochemical/radiological pancreatitis was conducted, using hospital archiving systems, reviewing operative notes and follow up events was conducted over an 8-year period. Results Within our benign specialist centre, 1393 patients were treated over an 8-year period. 73% of patients presenting with acute pancreatitis were male, whereas only 37% were female. The age range of patients presenting was 12 to 100 years, with the median age being 44 years. Within our population, 36.8% of acute pancreatitis was caused by gallstones, and 29.6% caused by alcohol and 33.6% other causes. 81% of patients seen had mild/moderate self-resolving pancreatitis requiring only fluids and analgesia. 19% had complicated pancreatitis requiring complex medical/surgical treatment.4.8% patients developed pancreatic necrosis, and 3.7% developed pancreatic pseudocysts. 8 patients required necrosectomy, 19 patients required cystogastrostomy and 1 patient required distal pancreatectomy with no 90-day mortality. Conclusions Our specialist unit with the support of gastroenterology, nutrition team, radiology and ITU have managed a large cohort of pancreatitic patients, the small number patients who require a surgical intervention have had good outcomes.

P-EUS03 Risk prediction in patients undergoing Endoscopic Necrosectomy for infected pancreatic necrosis

Background Laparotomy for the treatment of patients with infected pancreatic necrosis is associated with high rates of morbidity (∼95%) and mortality (∼50%); this has driven the development of minimally invasive alternatives for the treatment of such cases. Endoscopic Transgastric Necrosectomy (ETN) is an accepted method for debriding infected necrosis in these challenging cases. The National Emergency Laparotomy Audit (NELA) and P-POSSUM scoring systems are well-validated risk stratification tools used nationally for patients undergoing emergency laparotomy. This work aims to determine whether patients undergoing ETN for infected pancreatic necrosis can be risk stratified accurately using both the NELA and P-POSSUM scoring systems. Methods A prospective database of all patients in a single UK centre undergoing ETN from 2011 to 2021 for infected pancreatic necrosis has been maintained. All patients initially underwent an EUS guided stent placement to create a cystgastrostomy before subsequent transgastric necrosectomy. Patient demographics, timing of procedures and short-term post procedural outcomes were recorded. The NELA and P-POSSUM score was calculated at the time of the endoscopic cystgastrostomy. Demographic data were descriptively summarized and ROC analysis was performed to assess the diagnostic accuracy of both the P-POSSUM and NELA score. Data are presented as median (range) Results Sixty-nine patients underwent ETN between 2011 and 2021 with a median age of 54 years-(15-86). Twenty-nine patients-(42%) required ITU admission during their admission. The actual mortality was 10.1%-(7), which was slightly higher than the median of the NELA predicted mortality-(6.7%) but half the median of the P-POSSUM predicted mortality-(21.1%). Median overall predicted mortality for ETN using P-POSSUM was 21.1%-(2.6-85.7%) and with NELA was 6.7%-(0.4-34.3%). The median P-POSSUM score of the patients who died was 33.2%-(6.9-52.4%) compared to the median NELA score which was 17.2%-(0.8-34.3%). The area under the receiver operating characteristics curve-(AUROC) was similar for both the NELA-(0.82, SE = 0.13) and P-POSSUM-(0.75,-SE=0.1). Conclusions Endoscopic Transgastric Necrosectomy is a safe alternative to emergency laparotomy for the debridement of infected pancreatic necrosis. Both the NELA and P-POSSUM scoring systems can effectively stratify those patients at highest risk, however where P-POSSUM scoring may overestimate mortality NELA scoring may underestimate the severity of illness and mortality associated with the disease.

Novel Resection System for Direct Endoscopic Necrosectomy of Walled-Off Pancreas Necrosis: Have We Conquered the Final Frontier?

Surgical necrosectomy has been the traditional management for pancreatic necrosis and is done using blunt dissection. However, lack of dedicated endoscopic accessories has been a major limitation in direct endoscopic necrosectomy (DEN). Standard endoscopic accessories cannot effectively remove large necrotic material. Also, diameter of instrument channel of the endoscope limits the ability to use large-diameter graspers that can remove large chunks of necrotic material. In this news, we discuss a recent study that has evaluated a new powered endoscopic debridement system for DEN.