EGS SO34 - Idiopathic pancreatitis - a myth or a reality?

Abstract Background Acute pancreatitis is characterized by frequent episodes of inflammation in the pancreas.The most common causes are alcohol abuse and gallstones but approximately 30% of cases are defined as idiopathic because initial evaluation fails to detect the aetiology.This study aims to investigate the aetiology and the reasons for the incorrect labelling of patients with pancreatitis as idiopathic. Method This is a retrospective study and included patients with a diagnosis of idiopathic pancreatitis (IP) between 1 May 2019 and 31 April 2023.Cases were eligible for inclusion if they had been discharged as IP. Data were collected following review of patient notes into Microsoft Excel. Results A total of 129 patients were identified of whom the majority of patients did not find to have gallstones (88%), did not report alcohol use (91%), and did not experience trauma (87%). However, MRCP and EUS were not performed in all patients before they are labelled as idiopathic. Ultrasound was the most commonly performed diagnostic procedure (98%), while MRCP (40%) and EUS (8%) were less frequently utilized. Surprisingly, a quarter of patients underwent a laparoscopic cholecystectomy. Nutritional referrals were lacking in a significant portion of cases and the readmission rates were high (65%). Conclusion The most surprising elements in the data include the high incidence of unperformed diagnostic procedures to exclude the common causes of pancreatitis.Also,the underutilization of nutritional referrals and the high readmission rates suggest potential areas for improvement in the diagnostic workup and management of IP, as well as raising questions about the current clinical practices and their efficacy in this cohort.