Selznick Sydney, Mitrou Nicholas, Peck David, Hocking David, Sey Michael, Yan Brian M, Tang Ephraim, Leslie Ken, Hawel Jeff
Division of General Surgery, Western University, London, ON, Canada.
CSTAR (Canadian Surgical Technologies & Advanced Robotics), London Health Sciences Centre, 339 Windermere Rd, London, ON, N6A 5A5, Canada.
Surg Endosc. 2024 Dec;38(12):7459-7465. doi: 10.1007/s00464-024-11196-w. Epub 2024 Sep 3.
Benign Liver and Pancreas (BLiPs) rounds, implemented in 2022 at our Canadian tertiary care center, are a novel concept of a multidisciplinary case conference (MCC) for discussion of benign hepatopancreatobiliary (HPB) disease. BLiPs Rounds are a monthly virtual meeting of surgeons, gastroenterologists, and interventional radiologists experienced in biliary and pancreatic disease.
This case series was completed to review the patient cases discussed over the first year of BLiPs rounds, and to evaluate the effect of the multidisciplinary discussion on patient management plans. Meeting minutes were reviewed for BLiPs rounds between May 2022 and July 2023. Data were collected retrospectively on all discussed patients by review of the electronic medical record, and analyzed using frequencies and means with standard deviations.
Between May 2022 and July 2023, 56 cases were discussed at 12 case conferences. 68% of cases concerned pancreatic pathology, 25% concerned biliary pathology, the remainder liver or duodenal pathology. 49 cases (88%) were presented to discuss therapeutic options, and 7 presented as diagnostic challenges. Cases were usually presented once, but 7 patients were discussed at multiple conferences due to complex issues or ongoing symptomatology. 40 patients (71%) had undergone previous endoscopic, percutaneous, or surgical interventions prior to discussion. Endoscopic intervention was recommended in 32% of cases, percutaneous interventional approach in 13%, a combined endoscopic and percutaneous approach in 9%, and surgery in 18%. Repeat imaging or observation was recommended in 29% of cases. Discussion at rounds led to a change or adjustment in the proposed management in 46 cases (82%). The plan recommended by the MCC was carried out in 71% of cases.
BLiPs case conference provides a valuable venue to discuss cases, encourage interdisciplinary collaboration, and refine treatment approaches, leading to a change in proposed management plan in over three-quarters of cases presented.
2022年在我们加拿大的三级医疗中心实施的良性肝脏和胰腺（BLiPs）病例讨论会，是一种用于讨论良性肝胆胰（HPB）疾病的多学科病例会议的新概念。BLiPs病例讨论会是外科医生、胃肠病学家和在胆道及胰腺疾病方面经验丰富的介入放射科医生每月举行的虚拟会议。
完成该病例系列以回顾在BLiPs病例讨论会的第一年所讨论的患者病例，并评估多学科讨论对患者管理计划的影响。查阅了2022年5月至2023年7月期间BLiPs病例讨论会的会议记录。通过查阅电子病历对所有讨论过的患者进行回顾性数据收集，并使用频率和均值及标准差进行分析。
在2022年5月至2023年7月期间，在12次病例会议上讨论了56例病例。68%的病例涉及胰腺病理学，25%涉及胆道病理学，其余为肝脏或十二指肠病理学。49例（88%）病例是为讨论治疗方案而提出的，7例是作为诊断挑战提出的。病例通常只提出一次，但7例患者因问题复杂或症状持续而在多次会议上进行了讨论。40例患者（71%）在讨论前曾接受过内镜、经皮或手术干预。32%的病例建议进行内镜干预，13%建议采用经皮介入方法，9%建议采用内镜和经皮联合方法，18%建议进行手术。29%的病例建议重复成像或观察。病例讨论导致46例（82%）所提议的管理措施发生改变或调整。多学科病例会议建议的计划在71%的病例中得到了执行。
BLiPs病例会议为讨论病例、鼓励跨学科合作以及完善治疗方法提供了一个有价值的场所，导致超过四分之三提出的病例的提议管理计划发生改变。
