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SLUDGE AND MICROLITHIASIS WITH COMPARABLE CLINICAL OUTCOME COMPARED WITH GALLSTONE-INDUCED ACUTE BILIARY PANCREATITIS

Simon Sirtl 1, Katharina Bretthauer 1, Eric Hohmann 1, Mahmood Ahmad 1, Prince Allawadhi 1, Vanessa F. Schmidt 1, Christian Schulz 1, Jörg Schirra 1, Georg Beyer 1, Ujjwal M. Mahajan 1, Michal Zorniak 1,2, Julia Mayerle 1

Affiliations

1 LMU University Hospital, Munich, Germany

2 Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland

Summary

AI Generated

Microlithiasis and sludge-induced acute pancreatitis shows equivalent severity, cholestasis pattern, and outcomes compared to gallstone-induced pancreatitis in a 348-patient cohort study.

Microlithiasis and sludge-induced pancreatitis did not show a milder disease course than gallstone-induced pancreatitis when classified by revised Atlanta criteria (p = 0.63)
Mean bilirubin levels on admission were similar across groups: microlithiasis 3.6 mg/dl, sludge 2.6 mg/dl, and gallstones 3.5 mg/dl, with no significant difference (p = 0.067, normal range < 1.2 mg/dl)
EUS detection rates on day 1 were comparable: gallstone AP 44.82%, microlithiasis AP 46%, sludge AP 40.7% (p = 0.98), with highest detection occurring on admission day
ERCP extraction rates on admission day showed no significant difference: gallstone AP 39.1%, microlithiasis AP 25%, sludge AP 38.8% (p = 0.49)
The authors conclude that microlithiasis and sludge detected by EUS in early acute pancreatitis should be considered triggers rather than causes unless another aetiology is identified

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

Microlithiasis and sludge have been considered the largest aetiological drivers within the cohort of idiopathic acute pancreatitis for decades. Subsuming microlithiasis and sludge-induced pancreatitis patients into the idiopathic or gallstone-induced pancreatitis cohorts has so far made adequate risk assessment regarding pancreatitis outcome impossible. It is therefore still unclear whether different therapeutic approaches are needed for microlithiasis and sludge than for gallstone-induced pancreatitis.

Aims & Methods

348 patients with acute biliary pancreatitis treated at a high-volume pancreas centre from 2005 to 2021 were stratified into a total of 7 concrement groups using the new consensus definition for microlithiasis and sludge. The gallstone-pancreatitis cohort was compared with the microlithiasis and sludge cohort and all possible combination concrement groups with regard to pancreatitis disease progression (cholestasis pattern, EUS/ERCP results).

Results

Microlithiasis and sludge-induced pancreatitis as well as combination concrement groups classified according to the revised Atlanta classification did not show a milder course than gallstone-induced pancreatitis (p = 0.63). Microlithiasis (3.6 mg/dl; mean) and sludge (2.6 mg/dl; mean) showed an increase in bilirubin on the day of admission to hospital due to pancreatitis, which was not significantly different from gallstone-induced pancreatitis (3.5 mg/dl mean, normal range < 1.2 mg/dl; p = 0.067). The highest EUS concrement detection and ERCP concrement extraction rate occurred on the day of admission and day 1, respectively. EUS detection rate (day 1): Gallstone AP 44.82 % (n = 13/29), Microlithiasis AP 46 % (n= 7/15), Sludge AP 40.7 % (n = 11/27), p = 0.98; ERCP extraction rate (admission day): Gallstone AP 39.1 % (n = 18/46), Microlithiasis AP 25 % (n = 5/20),Sludge AP 38.8 % (n = 7/18); p = 0.49).

Conclusion

Microlithiasis and sludge achieve a gallstone-equivalent cholestasis pattern and also do not differ in pancreatitis outcome from gallstone-induced acute biliary pancreatitis. In the case of EUS detection of microlithiasis and sludge in the early phase of acute pancreatitis, the concrement should be considered as a trigger rather than a cause of pancreatitis (unless another aetiology can be detected).

Conference

UEG Week Copenhagen 2023

Topics

Pancreas

Submission format

Abstract

Session

PP 08 Pancreas (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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The Adipose-Driven Pancreatic Inflammatory Niche in Pancreatitis: Today and Tomorrow

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