Podda, Mauro; Pacella, Daniela; Pellino, Gianluca; Coccolini, Federico; Giordano, Alessio; Di Saverio, Salomone; Pata, Francesco; Ielpo, Benedetto; Virdis, Francesco; Damaskos, Dimitrios

Background/objectives: Reports about the implementation of recommendations from acute pancreatitis guidelines are scant. This study aimed to evaluate, on a patient-data basis, the contemporary practice patterns of management of biliary acute pancreatitis and to compare these practices with the recommendations by the most updated guidelines. Methods: All consecutive patients admitted to any of the 150 participating general surgery (GS), hepatopancreatobiliary surgery (HPB), internal medicine (IM) and gastroenterology (GA) departments with a diagnosis of biliary acute pancreatitis between 01/01/2019 and 31/12/2020 were included in the study. Categorical data were reported as percentages representing the proportion of all study patients or different and well-defined cohorts for each variable. Continuous data were expressed as mean and standard deviation. Differences between the compliance obtained in the four different subgroups were compared using the Mann-Whitney U, Student's t, ANOVA or Kruskal-Wallis tests for continuous data, and the Chi-square test or the Fisher's exact test for categorical data. Results: Complete data were available for 5275 patients. The most commonly discordant gaps between daily clinical practice and recommendations included the optimal timing for the index CT scan (6.1%, χ2 6.71, P = 0.081), use of prophylactic antibiotics (44.2%, χ2 221.05, P < 0.00001), early enteral feeding (33.2%, χ2 11.51, P = 0.009), and the implementation of early cholecystectomy strategies (29%, χ2 354.64, P < 0.00001), with wide variability based on the admitting speciality. Conclusions: The results of this study showed an overall poor compliance with evidence-based guidelines in the management of ABP, with wide variability based on the admitting speciality. Study protocol registered in ClinicalTrials.Gov (ID Number NCT04747990).

Aydin, Sonay; Fatihoglu, Erdem; Karavas, Erdal; Kantarci, Mecit

Introduction: Normal pancreatic thickness values on ultrasound (US) have been defined in literature. However, there is insufficient information about normal pancreatic measurements acquired from computed tomography (CT) or magnetic resonance imaging (MRI). To define normal pancreatic thickness measurements acquired from different localizations in order to provide reference values for more objectively identified parenchymal thickness changes. Materials and methods: A retrospective evaluation was made of the abdominal MRI examinations of 162 pediatric patients. Patients with any pancreatic disease, or chronic gastrointestinal inflammatory disease were excluded from the study. Measurements were taken from T2-weighted images. Results: Evaluation was made of 162 children, comprising 82 (50.6%) males and 80 (49.3%) females with a mean age of 9.8 ± 2.4 years. Mean pancreatic thickness was 18.3 ± 3.1 mm, 10.2 ± 2.9 mm, 14.9 ± 3 mm, 14.9 ± 3.3 mm in head, neck, body and tail localizations, accordingly. A positive correlation was determined between age, height, weight, body mass index (BMI) and pancreatic thickness in all the anatomic localizations (r > 0.55, p < 0.05). No significant difference was determined with gender. Interobserver agreement between two researchers was moderate and strong according to the different anatomic localizations. Conclusions: The defined normal ranges are mostly consistent with previously published US and CT based values. Pancreatic thickness values were positively correlated with age, height, weight and BMI for all four anatomical regions of the pancreas. Knowledge of normal pancreatic thickness values will increase the diagnostic accuracy of radiologists in the assessment of pancreatic diseases and may aid in interpreting atrophy in the setting of chronic pancreatitis.