Management of Idiopathic Acute Pancreatitis in Europe: An International Pancreas2000 Survey

Identifying the underlying cause of acute pancreatitis is fundamental for prevention of recurrence. However, no standardised algorithm for determining its aetiology exists.

This survey study aimed to investigate the international variations in diagnosis, workup protocols and follow-up of acute pancreatitis.

A 37-item international questionnaire was developed by a multidisciplinary team within the Pancreas 2000 program. The survey was distributed through social media platforms, e-mails and conference presentations. Responses were collected anonymously.

The survey received 247 responses from 36 countries, with 96% of respondents based in Europe; there were 56% gastroenterologists (N = 138), 34% surgeons (N = 84). Endoscopic ultrasound and magnetic resonance cholangiopancreatography were equally chosen as the preferred initial diagnostic test (34%, N = 85 each) in cases of acute pancreatitis without identified aetiology after the standard workup. Compared to surgeons, gastroenterologists used endoscopic ultrasound more (5% vs. 29%, p < 0.001) and favoured it as the ideal initial diagnostic tool for determining the aetiology (17% vs. 41%, p < 0.001). Most respondents (79%, N = 194) didn't recommend cholecystectomy when there was no evidence of biliary aetiology. The majority (89%, N = 220) recommended follow-up for moderate and severe acute pancreatitis with an unknown aetiology after initial admission; 17% (N = 42) did not recommend any follow-up.

This survey reveals significant disparities in the methods used to determine the aetiology of acute pancreatitis across different regions and centres within Europe. We share a common understanding that identifying the acute pancreatitis aetiology is critical to prevent recurrence. However, the absence of a validated protocol for this process is a notable gap in the clinical practice.