Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.
Heim Pál National Pediatric Institute, Budapest, Hungary.
United European Gastroenterol J. 2023 Oct;11(8):767-774. doi: 10.1002/ueg2.12402. Epub 2023 Jul 18.
There is a noteworthy overlap between the clinical picture of biliary acute pancreatitis (AP) and the 2018 Tokyo guidelines currently used for the diagnosis of cholangitis (AC) and cholecystitis (CC). This can lead to significant antibiotic and endoscopic retrograde cholangiopancreatography (ERCP) overuse.
We aimed to assess the on-admission prevalence of AC/CC according to the 2018 Tokyo guidelines (TG18) in a cohort of biliary AP patients, and its association with antibiotic use, ERCP and clinically relevant endpoints.
We conducted a secondary analysis of the Hungarian Pancreatic Study Group's prospective multicenter registry of 2195 AP cases. We grouped and compared biliary cases (n = 944) based on the on-admission fulfillment of definite AC/CC according to TG18. Aside from antibiotic use, we evaluated mortality, AC/CC/AP severity, ERCP performance and length of hospitalization. We also conducted a literature review discussing each criteria of the TG18 in the context of AP.
27.8% of biliary AP cases fulfilled TG18 for both AC and CC, 22.5% for CC only and 20.8% for AC only. Antibiotic use was high (77.4%). About 2/3 of the AC/CC cases were mild, around 10% severe. Mortality was below 1% in mild and moderate AC/CC patients, but considerably higher in severe cases (12.8% and 21.2% in AC and CC). ERCP was performed in 89.3% of AC cases, common bile duct stones were found in 41.1%.
Around 70% of biliary AP patients fulfilled the TG18 for AC/CC, associated with a high rate of antibiotic use. Mortality in presumed mild or moderate AC/CC is low. Each of the laboratory and clinical criteria are commonly fulfilled in biliary AP, single imaging findings are also unspecific-AP specific diagnostic criteria are needed, as the prevalence of AC/CC are likely greatly overestimated. Randomized trials testing antibiotic use are also warranted.
胆道急性胰腺炎（AP）的临床表现与目前用于胆管炎（AC）和胆囊炎（CC）诊断的 2018 年东京指南有显著重叠。这可能导致抗生素和内镜逆行胰胆管造影（ERCP）的过度使用。
我们旨在评估根据 2018 年东京指南（TG18）在胆道 AP 患者队列中 AC/CC 的入院时患病率，及其与抗生素使用、ERCP 和临床相关终点的关系。
我们对匈牙利胰腺研究小组前瞻性多中心登记的 2195 例 AP 病例进行了二次分析。我们根据 TG18 入院时满足明确 AC/CC 的胆道病例（n=944）进行分组和比较。除了抗生素使用外，我们还评估了死亡率、AC/CC/AP 严重程度、ERCP 表现和住院时间。我们还进行了文献综述，讨论了 TG18 的每个标准在 AP 中的情况。
27.8%的胆道 AP 病例符合 TG18 对 AC 和 CC 的诊断标准，22.5%的病例仅符合 CC 标准，20.8%的病例仅符合 AC 标准。抗生素使用率高（77.4%）。约 2/3 的 AC/CC 病例为轻度，约 10%为重度。轻度和中度 AC/CC 患者的死亡率低于 1%，但重度病例的死亡率明显较高（AC 和 CC 分别为 12.8%和 21.2%）。89.3%的 AC 病例进行了 ERCP，胆总管结石的检出率为 41.1%。
约 70%的胆道 AP 患者符合 TG18 对 AC/CC 的诊断标准，与高抗生素使用率相关。假定轻度或中度 AC/CC 的死亡率较低。胆道 AP 中通常满足实验室和临床标准，单一影像学表现也不具有特异性-需要 AP 特异性诊断标准，因为 AC/CC 的患病率可能被大大高估。也需要进行测试抗生素使用的随机试验。
