HPB SO52 - Ambulatory Management of Acute Pancreatitis (A-MAP) – Novel approach: A Pilot study

Abstract

Background
Acute pancreatitis (AP) is a very common problem, and its incidence is increasing over time. NICE guidelines, describes incidence of AP in UK is around 56 cases / 100000 population. Majority of AP cases are self-limiting, whereas only 15% of patients develop serious complications, with an overall mortality of 5%.

Traditionally, Patients with AP managed as inpatients with much pressure on NHS resources. As we now have better understanding of AP, pain becomes the main concern in management of AP, as most of cases are self-limiting.

The aim is to set a protocol for outpatient management of patients with mild AP.

Method
All patient diagnosed with mild acute pancreatitis according to revised Atlanta criteria (2012), aged 18 – 85, living within 1 hour from the hospital, and being attended by a responsible adult at home are eligible to be included in the study.

The management plan includes; pain control, antiemetic, PPIs, oral intake (fluids & low fat diet). A phone call next day of presentation. Patient review on the second day and tenth day following the presentation. All patient provided with Information leaflet with all warning symptoms and contact details in case of worsening symptoms.

Results
Over the period between March 2023 and April 2024, 18 patients (8 Males) with median age 47.5 (IQR 19) included in this prospective study. Ten patients have gallstones/biliary sludge, seven patients known to have alcoholic pancreatitis, & one patient where no cause could identified. All patients managed as outpatients as the protocol, except one female patient who lost follow up on day 2, as she reported no symptoms. Out of the 10 patients who have gallstones/ sludge; six patients had laparoscopic cholecystectomy and one patient had laparoscopic cholecystectomy with bile duct exploration within two weeks from their index presentation (70%).

Conclusion
This pilot study shows the feasibility of this novel approach of ambulatory management of patients presented with mild acute pancreatitis, with compliance to NICE guidelines by offering patients laparoscopic cholecystectomy within two weeks from presentation in cases of biliary pancreatitis. There is a need for a wider study possibly multicentre with the option of subgroup analysis by the cause of pancreatitis, frequency of presentation, and presence of element of chronic pancreatitis.