Title : Are patients admitted with gallstone pancreatitis being treated as per the current UK guidelines?
Abstract:
Introduction: Gallstone disease is the leading risk factor for pancreatitis, an inflammatory condition wherein the exocrine pancreas releases its enzymes prematurely, leading to auto-digestion. The British Society of Gastroenterology (BSG) 2005 guidelines recommend definitive gallstone management (cholecystectomy or ERCP with sphincterotomy) during the same admission unless clear treatment within two weeks is planned. For severe acute pancreatitis, intervention should be delayed until systemic disturbances resolve. This audit evaluated adherence to these guidelines at Birmingham Heartlands Hospital and identified areas for improvement.
Methods: Data was collected on approximately 100 patients admitted with gallstone pancreatitis between January 1st and June 30th 2023. The study assessed whether patients received treatment per BSG guidelines. For non-compliant cases, patients were followed for three months to monitor complications or readmissions. Variables analysed included time to diagnosis, risk stratification, complications, nutrition, and mortality. Data analysis was conducted using Microsoft Excel.
Results: Results showed 47% of patients did not receive appropriate interventions per BSG guidelines. Severity scores were documented in only 20% of cases. Antibiotics were administered to 59% of patients, with documented indications in 27%. Nutrition was managed well, with all patients receiving IV fluids and enteral nutrition. 9% were treated through the HTC pathway for laparoscopic cholecystectomy, and 29% were placed on the inpatient waiting list.
Conclusions: Improved severity score documentation and follow-up plans are crucial for guideline adherence and reducing readmission. Antibiotic use must be justified as it is not endorsed by the literature. A pro-forma based on guidelines and annual re-audits could enhance compliance.
