377 Idiopathic Pancreatitis: Are We Investigating Adequately? A Call for a National Standard Checklist

Abstract Aim Acute pancreatitis has an incidence of 15 to 42 cases per 100,000 population in the UK and carries a mortality rate of up to 7%, emphasising its clinical significance. Approximately 30% of cases are classified as idiopathic, with microlithiasis implicated in up to 80% of these. The Practical Guide to the Management of Acute Pancreatitis (2018) by the British Society of Gastroenterology (BSG) recommends the use of Endoscopic Ultrasound (EUS) to detect microlithiasis, with reported diagnostic yields ranging from 32% to 88%. This study aimed to evaluate adherence to these guidelines in the investigation of pancreatitis aetiology and to identify deficiencies in current clinical practice. Method A retrospective audit was conducted at a busy district general hospital, reviewing all pancreatitis admissions between March and August 2024. Data were collected from electronic patient records. Each case was assessed for appropriate aetiological workup during the initial admission, with specific attention to the use of EUS in idiopathic cases. Results Sixty-eight admissions were identified. Gallstones (34%) and alcohol (30%) were the most common causes, accounting for 64% of cases. Other causes included hypertriglyceridemia, biliary sludge, cholangiocarcinoma, trauma, and post-ERCP pancreatitis (13%). Two patients remained under investigation, and seven were lost to follow-up. Six cases (9%) were labelled idiopathic; none of these underwent EUS. Conclusions There is a clear gap in the investigation of idiopathic pancreatitis, with no patients receiving guideline-recommended EUS. Introducing a national standardised checklist may improve adherence to investigative protocols and ensure comprehensive evaluation and follow-up.