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HYPERCALCEMIA CAUSES MORE SEVERE PANCREATITIS

Gábor Gieszinger 1, Balázs Kui 1, Peter Hegyi 2, Peter Jeno Hegyi 2, Áron Vincze 3, Balint Eross 4, Andrea Szentesi 5, Vivien Vass 2, Zsolt Abonyi Tóth 2, Ferenc Izbéki 6, László Czakó 1

Affiliations

1 Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary

2 Centre for Translational Medicine, Semmelweis University, Budapest, Hungary

3 University of Pécs, Pécs, Hungary

4 Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary

5 Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary

6 Szent György Teaching Hospital of County Fejér, Székesfehérvár, Hungary

Summary

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In a multi-registry study of 1867 acute pancreatitis patients, hypercalcemia-induced disease was rare but carried significantly higher risk of severe pancreatitis and renal failure compared to other etiologies.

Hypercalcemia was the sole etiology in 1.02% of acute pancreatitis cases (19/1867), with an additional 3.75% having mixed etiology including hypercalcemia.
Severe acute pancreatitis occurred in 21.05% of hypercalcemia-induced cases versus 6.13% of controls, with an odds ratio of 4.08 (95% CI 1.08-15.38).
Renal failure was significantly more frequent in hypercalcemia-induced pancreatitis at 27.27% versus 5.35% in controls, with an odds ratio of 6.63 (95% CI 1.36-32.35).
No significant differences were observed in laboratory markers, mortality, ICU admission, pancreatic necrosis, or pseudocyst formation between hypercalcemic and control groups.
The severity of hypercalcemia itself did not influence acute pancreatitis outcomes within the hypercalcemic subgroup.

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Abstract

Introduction

Acute pancreatitis (AP) is one of the most common gastroenterological diseases requiring admission to the hospital. The main etiological factors of AP are gallstones and excessive alcohol consumption, but rarer causes, such as hypercalcemia, should keep on mind. Only few cases are reported in the literature, and the severity of hypercalcaemia-induced acute pancreatitis is not known.

Aims & Methods

We aim to assess the occurrence and severity of hypercalcaemia-induced AP and compare it with the clinical characteristics of AP caused by other etiological factors. We collected patients from the Hungarian Acute Pancreatitis Registry, Hungarian GOULASH study and the Europe-wide EASY study, who had AP and had a serum calcium level above 2.6 mmol/l. Patients were divided into three groups: hypercalcemia-induced AP, where no other etiology than hypercalcemia were present, mixed etiology group, where both hypercalcemia and other etiologies were revealed and the control group with normal serum calcium level. Propensity score matching adjusted by age, sex, diabetes, lipid disorder, previous pancreatic disease was made and several outcome parameters were analyzed during the statistical analysis. Hypercalcemic cases were divided into 3 subgroups based on the level of serum calcium: mild (2.6< >3.0 mmol/l), moderate (3.0 < >3.5 mmol/l) or severe hypercalcemia (>3.5 mmol/l).

Results

1.02% of our AP patients (19/1867) had clear hypercalcemic etiology and 3.75 % (70/1867) of the patients had mixed etiology, 1778 patients were in the control group. There was no difference in the mean ages of the patients in the three groups (57.3± 16.3 and 56.1 ± 20.1 vs. 55.1 ± 14.6 years). Severe AP was significantly more frequent in patients with hypercalcemia-induced AP compared to the control group [21.05% (4/19) vs 6.13% (109/1778); odds ratio: 4.08 (95% CI, 1.08-15.38)]. Renal failure was more frequent in hypercalcemic etiology compared to AP patients with normal serum calcium level [27.27% (3/11) vs 5.35% (95/1776); odds ratio: 6.63, (95% CI, 1.36-32.35)]. There was no significant difference in CRP, amylase, lipase, WBC, creatinine, length of hospital stay, mortality, intensive care admission, the presence of pancreatic necrosis, pseudocysts, and other organ failure between the hypercalcemic or mixed etiology and the control groups. There was no significant difference in the severity of AP between the mixed etiology and normal serum calcium groups. The outcome of acute pancreatitis was not influenced by the severity of hypercalcemia within the hypercalcemic group.

Conclusion

Hypercalcemia-induced AP has a higher risk for developing into severe AP and renal failure compared to other etiology.

Conference

UEG Week Vienna 2024

Topics

Pancreas

Submission format

Abstract

Session

PANCREAS (Posters)

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

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Current role for thiopurines in the management of IBD: Should I go?

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Current role for thiopurines in the management of IBD: Should I go?

Joana Torres 1

Affiliations

1 Hospital Beatriz Ângelo & Hospital da Luz, Lisbon, Portugal

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Abstract

Event

Postgraduate Teaching Programme Barcelona 2026

Topics

Immunology Mechanisms & Personalised Medicine IBD

Session

Thiopurines in IBD: Should I stay or should I go

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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Palliative endoscopy: How to get the best of all worlds (ERCP, EUS, PTC)

Ilaria Tarantino 1

Affiliations

1 ISMETT, Palermo, Italy

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Abstract

Event

UEG Postgraduate Teaching Programme Berlin 2025

Topics

Digestive Oncology Endoscopy Hepatobiliary Surgery

Session

Cholangiocarcinoma secrets unveiled

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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NOVEL APPROACH TO BILATERAL BILIARY DRAINAGE: SINGLE-SESSION DUAL-ROUTE EUS-GUIDED HEPATICODUODENOSTOMY PLUS HEPATICOGASTROSTOMY FOR MALIGNANT HILAR BILIARY OBSTRUCTION: A PROSPECTIVE STUDY

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NOVEL APPROACH TO BILATERAL BILIARY DRAINAGE: SINGLE-SESSION DUAL-ROUTE EUS-GUIDED HEPATICODUODENOSTOMY PLUS HEPATICOGASTROSTOMY FOR MALIGNANT HILAR BILIARY OBSTRUCTION: A PROSPECTIVE STUDY

SUSUMU HIJIOKA 1, Yoshikuni Nagashio 1, Shota Harai 1, Daiki Yamashige 1, Yutaka Saito 2, Takuji Okusaka 1

Affiliations

1 National Cancer Center Hospital, Tokyo, Japan

2 National Cancer Center Hospital Endoscopy Division, Tokyo, Japan

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Abstract

Introduction

Biliary drainage for malignant hilar obstruction (MHBO), particularly involving the right intrahepatic duct, remains technically challenging. Endoscopic retrograde cholangiopancreatography (ERCP) often fails in complex hilar strictures, while percutaneous transhepatic biliary drainage (PTBD) is associated with external catheter-related morbidity.
Endoscopic ultrasound-guided biliary drainage (EUS-BD) provides an alternative internal drainage route; however, an optimal strategy for bilateral drainage has not been established.
Based on our previous retrospective study, we evaluated a novel dual-route drainage technique combining hepaticoduodenostomy and hepaticogastrostomy (EUS-HDGS) in a prospective setting. This study aimed to evaluate its efficacy and safety.

Aims & Methods

This was a prospective single-arm phase II study of patients with unresectable malignant hilar biliary obstruction (Bismuth II–IV) requiring bilateral drainage.
EUS-HDGS was performed in a single session, consisting of hepaticoduodenostomy (HDS) for right-sided drainage followed by hepaticogastrostomy (HGS) for left-sided drainage.
The primary endpoint was clinical success, defined as ≥50% reduction or normalization of serum bilirubin within 14 days. Secondary endpoints included technical success, adverse events, recurrent biliary obstruction (RBO), stent patency, and re-intervention success.

Results

Eighteen patients were included.
Technical success was achieved in 16/18 patients (89%), and clinical success in 14/16 patients (88%). Procedure-related adverse events occurred in 4/18 patients (22%), all of which were mild to moderate and managed conservatively.
During follow-up, the median stent patency was 141 days (95% CI: 82.5–199.5), with a median event-free survival of 108 days (95% CI: 56.4–160) and a median overall survival of 134 days (95% CI: 97.9–170). Recurrent biliary obstruction occurred in 7/18 patients (39%); re-intervention was performed in 6 patients and was successful in all cases (100%), confirming reliable endoscopic re-accessibility.

Conclusion

EUS-HDGS enables effective bilateral internal drainage with durable patency and reliable re-intervention, offering a feasible endoscopic alternative for complex malignant hilar obstruction.

Event

UEG Week Barcelona 2026

Topics

Pancreas Radiology & Imaging Hepatobiliary Endoscopy

Submission format

Abstract

Session

Biliary clinical care: New frontiers in biliary endoscopy

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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Abstract

Event

UEG Week Berlin 2025

Topics

Endoscopy Hepatobiliary

Session

EUS-guided biliary drainage

Citation

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Published

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Aurelio Mauro 1

Affiliations

1 IRCCS Foundation San Matteo Hospital, Pavia, Italy

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Abstract

Event

UEG Postgraduate Teaching Programme Berlin 2025

Topics

Endoscopy Surgery

Session

Is there really an added value for all new EUS/ERCP techniques?

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

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ENHANCING OUTCOMES IN DECOMPENSATED CIRRHOSIS: A MULTICENTER STUDY ON THE IMPACT OF A CARE BUNDLE APPROACH

Luís Santos 1, Rita Regatia 2, Mara Costa 1, Inês Costa Santos 3, Claudia Agostinho 1, Dario Gomes 1,4, Ana Oliveira 3, Pedro Narra Figueiredo 1,4

Affiliations

1 Unidade Local de Saúde de Coimbra, Coimbra, Portugal

2 Portuguese Oncology Institute of Coimbra, Coimbra, Portugal

3 Unidade Local de Saúde da Arrábida, Setúbal, Portugal

4 Faculty of Medicine, University of Coimbra, Coimbra, Portugal

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Abstract

Introduction

Chronic liver disease remains one of the most common causes for hospital admission and is associated with high morbidity and mortality rates. Timely and adequate management within the first 24 hours is crucial for improving clinical outcomes in cases of decompensated cirrhosis. This study aimed to evaluate the impact of implementing a care bundle checklist during the first 24 hours of hospital admission on management and outcomes of decompensated cirrhosis.

Aims & Methods

We developed an adapted care bundle (based on the BSG/BASL care bundle, AASLD quality measures proposal, Baveno VII consensus, and EASL guidelines) and compared two patient groups from two Portuguese hospital centers: Group-A (retrospective, pre-care bundle implementation) and Group-B (prospective, post-care bundle implementation).

Results

A total of 224 patients (Group-A: 148; Group-B: 76) were included. More than one decompensation was observed in 118 patients (52.7%), and 69 patients (30.8%) were experiencing their index hospitalization for liver decompensation. Regarding etiology, alcoholic liver disease was the most common (n=200; 89.3%). The groups were similar in terms of gender, age, length of hospital stay, and Child-Pugh and MELD-Na scores at admission. The most common decompensations were gastrointestinal bleeding (n=91; 40.6%), ascites (n=75; 33.5%), and hepatic encephalopathy (n=72; 32.1%). Group B was more likely to present with multiple decompensations at admission and exhibited significantly higher rates of acute kidney injury, hepatocellular carcinoma, acute-on-chronic liver failure, and portal vein thrombosis (p<0.05). Following care bundle implementation, we found significant improvements in patient care. At admission, patients were significantly more likely to undergo urine and blood cultures, chest X-ray, and abdominal ultrasound (p<0.05), receive diagnostic paracentesis (p<0.05), and have an accurate alcohol history documented (p=0.04). During admission, Group-B was significantly more likely to be prescribed lactulose for encephalopathy prophylaxis, vasopressor therapy for gastrointestinal bleeding, and venous thromboembolism prophylaxis, as well as undergo nutritional assessment (p<0.05). While in-hospital mortality rates were similar (4.7% vs. 5.3%; p=1), 6-week mortality rates (8.8% vs. 3.9%; p=0.01) and 3-month readmission rates (31.1% vs. 15.8%; p=0.02) were significantly lower in the post-intervention cohort.

Conclusion

The implementation of a standardized care bundle was associated with higher rates of appropriate investigation and treatment within the first 24 hours of hospital admission and improved patient outcomes, reducing 6-week mortality and 3-month readmission rates.

Conference

UEG Week Berlin 2025

Topics

Hepatobiliary

Submission format

Abstract

Session

LIVER (Posters)

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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