Mild acute biliary pancreatitis: still a surgical disease. A post-hoc analysis of the MANCTRA-1 international study

Background: The current standard of care for mild acute biliary pancreatitis (MABP) involves early laparoscopic cholecystectomy (ELC) to reduce the risk of recurrence. The MANCTRA-1 project revealed a knowledge-to-action gap and higher recurrence rates in patients admitted to medical wards, attribut...

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Detalles Bibliográficos
Autores: Cioffi, Stefano Piero Bernardo, Spota, Andrea, Virdis, Francesco, Altomare, Michele, Mingoli, Andrea, Cimbanassi, Stefania, Nava, Francesca Laura, Nardi, Silvana, Di Martino, Marcello, Di Saverio, Salomone, Ielpo, Benedetto, Pata, Francesco, Pellino, Gianluca, Sartelli, Massimo, Damaskos, Dimitrios, Coccolini, Federico, Pisanu, Adolfo, Catena, Fausto, Podda, Mauro, MANCTRA-1 study group
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2025
País:España
Institución:Universitat Pompeu Fabra
Repositorio:Repositorio Digital de la UPF
OAI Identifier:oai:repositori.upf.edu:10230/71871
Acceso en línea:http://hdl.handle.net/10230/71871
http://dx.doi.org/10.1007/s00068-024-02748-9
Access Level:acceso abierto
Palabra clave:Acute biliary pancreatitis
Early cholecystectomy
Guidelines
Mild
Readmission
Recurrence
Descripción
Sumario:Background: The current standard of care for mild acute biliary pancreatitis (MABP) involves early laparoscopic cholecystectomy (ELC) to reduce the risk of recurrence. The MANCTRA-1 project revealed a knowledge-to-action gap and higher recurrence rates in patients admitted to medical wards, attributable to fewer ELCs being performed. The project estimated a 35% to 70% probability of narrowing this gap by 2025. This study evaluates the safety of suboptimal ELC implementation and identifies risk factors for recurrent acute biliary pancreatitis (RAP) in patients not undergoing ELC after an MABP episode. Methods: We conducted a post-hoc analysis of the MANCTRA-1 registry, including MABP patients who did not undergo ELC during the index hospitalization, excluding those with related complications. The primary outcome was the 30-day hospital readmission rate due to RAP. We performed multivariable logistic regression to find risk factors associated with the primary outcome. Results: Between January 2019 and December 2020, 1920, MABP patients from 150 centers were included in the study. The 30-day readmission rate due to RAP was 6%. Multivariable logistic regression found the admission to a medical ward (internal medicine or gastroenterology) (OR = 1.95, p = 0.001) and a positive COVID-19 test (OR = 3.08, p = 0.029) as independent risk factors for RAP. Conclusion: Our analysis offers valuable insights into the management of MABP, particularly in centers where ELC cannot be fully implemented due to logistical and clinical constraints, worsened by the COVID-19 pandemic. Regardless of the admitting ward, prompt access to surgical care is crucial in reducing the risk of early recurrence, highlighting the need to implement surgical consultation pathways within MABP care bundles.

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