Miguel Salazar, MD1, James S. Ramey, MD2, Jodie A. Barkin, MD3, Rudolf Kumapley, MD4, Isaac Paintsil, MBChB, MPH1, Jamie S. Barkin, MD, MACG3, C. Roberto Simons-Linares, MD, MSc5
1John H. Stroger, Jr. Hospital of Cook County, Chicago, IL; 2Baylor College of Medicine, Houston, TX; 3University of Miami Miller School of Medicine, Miami, FL; 4Cook County Health and Hospital Systems, Chicago, IL; 5Cleveland Clinic, Cleveland, OH
Introduction: Acute Pancreatitis can be complicated by pancreatic necrosis and or pancreatic/peripancreatic fluid collections. The effects of cannabis and the incidence of necrosis and/or pancreatic/peripancreatic fluid collections have not been yet studied. We sought to investigate if cannabis users had less incidence of pancreatic necrosis and/or pancreatic/peripancreatic fluid collections and to ascertain the clinical effects cannabis use has on severity and outcomes in this group of patients.
Methods: We performed a retrospective cohort study of all consecutive patients admitted with a first episode of acute pancreatitis at a large tertiary referral center in Chicago, IL from 01/01/2012 to 04/30/2018. Acute pancreatitis diagnosis and severity were identified as per the Revised Atlanta Classification. Presence of pancreatic necrosis or pancreatic/peripancreatic fluid was stablished by radiologic imaging or histopathologic evaluation. Use of cannabis was identified via recorded history and/or urine toxicology. A multivariate logistic regression model was constructed using STATA software version 13 (STATA Corp LLC College Station Texas, USA).
Results: Five hundred and nineteen patients were included, from which 107 (20.6%) were cannabis users (CU). A total of 69 patients developed acute necrotizing pancreatitis; 58 (84%) were non-cannabis users (N-CU) and 11 (16%) were CU A total of 109 patients with moderate-severe acute pancreatitis developed pancreatic/peripancreatic fluid collections, 92(84.4%) were NCU and 17 (16.6%) were CU. Acute necrotizing pancreatitis outcomes: CU were more likely to have persistent SIRS (18.2% vs. 12.1%) and to require ICU (63.6% vs. 43.1%), they were also less likely to have Infected necrosis (9.1% vs. 51.7%), bacteremia (18.2% vs. 31%), to require debridement of necrosis (9.1% vs. 32.8%). CU with any pancreatic/peripancreatic fluid collection were more likely to have AKI (47.1% vs. 26.1%).
Discussion: Cannabis users with acute necrotizing pancreatitis or fluid collection are more likely to have persistent SIRS, AKI and require ICU. However, they’re less likely to have infected necrosis/fluid collections, bacteremia and to require pancreatic/peripancreatic fluid debridement. This is a pioneer study to investigate the clinical impact of cannabis use in acute pancreatitis, including outcomes and severity in patients with pancreatic necrosis and pancreatic/peripancreatic fluid collections.
Citation: Miguel Salazar, MD; James S. Ramey, MD; Jodie A. Barkin, MD; Rudolf Kumapley, MD; Isaac Paintsil, MBChB, MPH; Jamie S. Barkin, MD, MACG; C. Roberto Simons-Linares, MD, MSc. P0012 - OUTCOMES OF ACUTE NECROTIZING PANCREATITIS AND ASSOCIATED FLUID COLLECTIONS IN CANNABIS USERS. Program No. P0012. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.