Insufficient implementation of the IAP/APA guidelines on aetiology in acute pancreatitis: Is there a need for implementation managers in pancreatology?

Zádori, Noémi; Párniczky, Andrea; Szentesi, Andrea; Hegyi, Péter

doi:10.1177/2050640620918695

Cited by 16 publications

(27 citation statements)

References 11 publications

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“…The majority of the included cohort studies (108 out of 128) collected data from the 2010′s. Our meta-analysis contains 102 single 20 – 121 and 23 multicentre studies 122 – 144 . In two cases, there were no relevant data regarding the number of centres involved 145 , 146 .…”

Section: Resultsmentioning

confidence: 99%

Assessment of the course of acute pancreatitis in the light of aetiology: a systematic review and meta-analysis

Bálint

Für

Kiss

et al. 2020

Sci Rep

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The main causes of acute pancreatitis (AP) are biliary disease, alcohol consumption, hypertriglyceridaemia (HTG) and endoscopic retrograde cholangiopancreatography (ERCP). The aim of this meta-analysis was to evaluate the effects of these aetiological factors on the severity and outcome of AP. Pubmed and Embase were searched between 01/01/2012 and 31/05/2020. Included articles involved adult alcoholic, biliary, HTG- or post-ERCP AP (PAP) patients. Primary outcome was severity, secondary outcomes were organ failures, intensive care unit admission, recurrence rate, pancreatic necrosis, mortality, length of hospital stay, pseudocyst, fluid collection and systematic inflammatory response syndrome. Data were analysed from 127 eligible studies. The risk for non-mild (moderately severe and severe) condition was the highest in HTG-induced AP (HTG-AP) followed by alcoholic AP (AAP), biliary AP (BAP) and PAP. Recurrence rate was significantly lower among BAP vs. HTG-AP or AAP patients (OR = 2.69 and 2.98, 95% CI 1.55–4.65 and 2.22–4.01, respectively). Mortality rate was significantly greater in HTG-AP vs. AAP or BAP (OR = 1.72 and 1.50, 95% CI 1.04–2.84 and 0.96–2.35, respectively), pancreatic necrosis occurred more frequently in AAP than BAP patients (OR = 1.58, 95% CI 1.08–2.30). Overall, there is a potential association between aetiology and the development and course of AP. HTG-AP is associated with the highest number of complications. Furthermore, AAP is likely to be more severe than BAP or PAP. Greater emphasis should be placed on determining aetiology on admission.

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Section: Resultsmentioning

confidence: 99%

Assessment of the course of acute pancreatitis in the light of aetiology: a systematic review and meta-analysis

Bálint

Für

Kiss

et al. 2020

Sci Rep

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“…The multiple-hit theory can be implemented in the pathogenesis of AP[ 24 ]; therefore, information on possible contributing factors was collected for each case (Table 2 ). Multiple etiological factors are often responsible for AP[ 24 ], but the lack of proper workup often leads to cases being deemed idiopathic or an important factor not being discovered due to the presence of a more convenient diagnosis[ 6 ]. In addition to the established etiological factors, various mechanisms have been postulated as the cause of pancreatic damage in COVID-19.…”

Section: Discussionmentioning

confidence: 99%

“…Also, before entertaining the possibility of a new virus as a causative agent in cases where no apparent etiological factors are present, other, less frequent causes of AP must be considered. In such cases, the International Association of Pancreatology/American Pancreatic Association (IAP/APA) recommendations should be followed[ 6 , 7 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…Viral infections such as mumps, Coxsackie, hepatitis, and herpes viruses are known causes of pancreatitis[ 5 ]. There is a strong possibility that, like other, less common causes of acute pancreatitis (AP), infectious etiology is underdiagnosed on account of the insufficient workup of idiopathic cases and cases where an apparent cause ( e.g., alcohol consumption) is already established[ 6 - 8 ].…”

Section: Introductionmentioning

confidence: 99%

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Insufficient etiological workup of COVID-19-associated acute pancreatitis: A systematic review

Juhász¹,

Ocskay²,

Kiss³

et al. 2020

WJG

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BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, mostly causing respiratory symptoms, is also known to affect the gastrointestinal tract. Several case reports hypothesize that SARS-CoV-2 could be an etiological factor in acute pancreatitis (AP). AIM To assess all the available evidence in the literature relating to coronavirus disease 2019 (COVID-19) and AP. METHODS We performed a systematic review of the available literature on the topic. The systematic search was conducted on 15 May 2020 on MEDLINE, EMBASE, CENTRAL, Web of Science and Scopus with a search key using the terms “amylase,” “lipase,” “pancr*,” “COVID-19” and synonyms. Due to the low quality and poor comparability of the studies, a meta-analysis was not performed. RESULTS Six case reports and two retrospective cohorts were included, containing data on eleven COVID-19 patients with AP. Five patients had AP according to the Atlanta classification. Other publications did not provide sufficient information on the diagnostic criteria. Most cases were considered SARS-CoV-2-induced, while several established etiological factors were not investigated. We were able to identify other possible causes in most of them. CONCLUSION We strongly highlight the need for adherence to the guidelines during a diagnostic and etiological workup, which could alter therapy.

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“…These guidelines share the roles of practice guidelines but must adhere to reproducible standards (e.g., the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system) when rating quality of evidence and formulating the strength of recommendations (main target audience: clinical practitioners and scientists) [43,44]. Unfortunately, there is a huge gap between the publication of a guideline and its actual implementation [45]. Furthermore, guideline adherence is poor in various fields of medicine [46].…”

Section: Practice Guidelinesmentioning

confidence: 99%

Academia Europaea Position Paper on Translational Medicine: The Cycle Model for Translating Scientific Results into Community Benefits

Hegyi

Petersen

Holgate

et al. 2020

JCM

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Introduction: Translational science has gained prominence in medicine, but there is still much work to be done before scientific results are used optimally and incorporated into everyday health practice. As the main focus is still on generating new scientific data with financial resources primarily available for that purpose, other activities that are necessary in the transition from research to community benefit are considered less needy. The European Statistical Office of the European Commission has recently reported that 1.7 million people under 75 years of age died in Europe in 2016, with around 1.2 million of those deaths being avoidable through effective primary prevention and public health intervention. Therefore, Academia Europaea, one of the five Pan-European networks that form SAPEA (Science Advice for Policy by European Academies), a key element of the European Commission’s Scientific Advice Mechanism (SAM), has launched a project to develop a model to facilitate and accelerate the utilisation of scientific knowledge for public and community benefit. Methods: During the process, leaders in the field, including prominent basic and clinical researchers, editors-in-chief of high-impact journals publishing translational research articles, translational medicine (TM) centre leaders, media representatives, academics and university leaders, developed the TM cycle, a new model that we believe could significantly advance the development of TM. Results: This model focuses equally on the acquisition of new scientific results healthcare, understandable and digestible summation of results, and their communication to all participants. We have also renewed the definition in TM, identified challenges and recommended solutions. Conclusion: The authors, including senior officers of Academia Europaea, produced this document to serve as a basis for revising thinking on TM with the end result of enabling more efficient and cost-effective healthcare.

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Insufficient implementation of the IAP/APA guidelines on aetiology in acute pancreatitis: Is there a need for implementation managers in pancreatology?

Cited by 16 publications

References 11 publications

Assessment of the course of acute pancreatitis in the light of aetiology: a systematic review and meta-analysis

Assessment of the course of acute pancreatitis in the light of aetiology: a systematic review and meta-analysis

Insufficient etiological workup of COVID-19-associated acute pancreatitis: A systematic review

Academia Europaea Position Paper on Translational Medicine: The Cycle Model for Translating Scientific Results into Community Benefits

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