A Study of Interventions in Acute Pancreatitis at a Tertiary Care Hospital – An Indian Experience

Background: Acute pancreatitis is a common gastro-intestinal disease with varied etiology, presentations, management and outcomes. Over the years the management has evolved from surgical to conservative under intensive care setting. Here we have attempted to study various interventions in the management of acute pancreatitis and correlate clinical/radiological severity indices with likelihood of interventions and outcome. Material And Methods: In this combined Retrospective-Prospective Observational study we have included 148 patients of diagnosed acute pancreatitis. Detailed history, clinical parameters, laboratory investigations, imaging findings, BISAP (Bedside Index for predicting Severe Acute Pancreatitis) score and Ctsi (Ct Severity Index), interventions, complications and outcome were recorded and analyzed. Results: According to BISAP score, 72(49%) had score of 0, 47(32%) had 1, 22(15%), 5(3%) and 2(1%) had scores of 2, 3 and 4 respectively while none had 5. CTSI was available for 112 patients out of which 94(84%) had between 0–6 and 18(16%) had 7–10. Initial conservative management was adequate in 119(80%) patients. 29(20%) patients required some intervention: endoscopic (5%), radiologic (8%) or surgical (7%). 9 patients required a second interventional treatment. Overall mortality was 10%. Statistically significant correlation was found between CTSI – likelihood of intervention/re-intervention and BISAP score – outcome (mortality) [p<0.001]. Conclusion: Aggressive conservative management remains the mainstay of treatment majority patients of acute pancreatitis. Tailored interventions are required in selected group of patients. CTSI correlates well with likelihood of intervention/re-intervention and BISAP score correlates well with outcome [mortality].