Priyanjali Pulipati, MBBS1, Misbah Unnisa, PharmD2, Nageshwar D. Reddy, MBBS, MD, DM2, Rupjyoti Talukdar, MBBS, MD2
1Asian Institute of Gastroenterology, Iowa City, IA; 2Asian Institute of Gastroenterology, Hyderabad, Telangana, India
Introduction: Pancreatic fluid collections (PFCs) resulting from acute pancreatitis (AP) can be associated with infections and mass effect. The aim of this study was to evaluate the natural history of PFCs in AP.
Methods: In this study, we so far included 65 patients with PFCs retrospectively (presented to the Pancreas clinic with a history of AP) and 44 prospectively (hospitalized patients). In this abstract, we will present data on only the retrospectively enrolled patients. Patients underwent a thorough demographic and clinical history. We also recorded PFC morphology, presence of venous thrombosis and need for interventions at baseline and each follow-up visit.
Results: The mean(SD) age of the patients was 36.45 ± 13.49 years with 58(89.2%) males. The etiology included alcohol in 26(40%), smoking in 5(7.6%), cholelithiasis in 5(7.6%), and idiopathic in 29(44.6%) patients. 63(96.9%) patients had moderately severe while 2(3%) had severe disease. At presentation, the first episode of AP was seen in 22(33.8%), recurrent in 27(41.5%) and acute on chronic in 16(24.6). The type of fluid collections included APFC in 7(10.8%), ANC in 5(7.7%), pseudocyst in 4(6.2%) and WOPN in 49(75.4%). During the first 3 months, the mean volume of fluid collections was 326.4 ± 637.3 and venous thrombosis developed in 21(32.3%) patients. 17(26.1%) patients required interventions in the first 3 months while 5(7.7%) in the next 3 months. Venous thrombosis developed in 8(12.3%) additional patients during the next 3 months. Overall, the most common intervention was EUS guided cystogastrostomy(CG) with SEMS placement in 7(10.6%), followed by PCD in 6(9.2%), surgical CG in 5(7.7%), EUS guided plastic stent placement in 1(1.5%) and combined procedures in 3(4.6%). Among patients not undergoing intervention during the first 3months, spontaneous complete resolution was seen in 13(20%) patients, while a reduction and increase in size was seen in 18(27.6%) and 17(26.2%) patients respectively. Among the patients who did not undergo intervention between 3rd to 6th months, complete resolution was observed in 36(55.4%) patient, while a decrease and increase in size were seen in 11(16.9%) and 9(13.8%) patients respectively. Among the patients who underwent interventions during the first and next 3 months, relapse/increase in PFC size was seen in 4(6.2%) and 2(3.1%) patients respectively.
Discussion: 3/4th of PFCs undergo spontaneous resolution within 6 months while most relapses and venous thrombosis occur within the first 3 months.
Citation: Priyanjali Pulipati, MBBS; Misbah Unnisa, PharmD; Nageshwar D. Reddy, MBBS, MD, DM; Rupjyoti Talukdar, MBBS, MD. P0027 - NATURAL HISTORY OF PANCREATIC FLUID COLLECTIONS IN ACUTE PANCREATITIS. Program No. P0027. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.