Acute pancreatitis in Hong Kong

Area of Science:

• Gastroenterology
• Hepatobiliary Surgery
• Clinical Medicine

Background:

• Acute pancreatitis is a significant gastrointestinal condition.
• Biliary tract disease is a common cause of acute pancreatitis, particularly in certain populations.
• Recurrent pyogenic cholangitis is prevalent in the indigenous population, influencing treatment strategies.

Purpose of the Study:

• To review a decade of acute pancreatitis cases in Chinese patients at a Hong Kong hospital.
• To analyze the etiological factors, clinical presentation, and treatment outcomes.
• To evaluate the safety and efficacy of surgical interventions during acute episodes.

Main Methods:

• Retrospective review of 311 Chinese patients with acute pancreatitis.
• Analysis of patient demographics, clinical data, etiological factors (biliary disease, stones, parasites), and treatment modalities.
• Comparison of mortality rates between conservative treatment, emergency surgery (common duct decompression), and other surgical interventions (sphincteroplasty, subtotal pancreatectomy).

Main Results:

• Biliary tract disease was identified in 52.4% of patients, with stones/mud/parasites in the common bile duct in 77.9%.
• Fever and jaundice were present in 55% and 41.2% of patients, respectively.
• Emergency operations for common duct decompression were performed in 54.3% with a 14.8% mortality; conservative treatment had a 3.5% mortality (all hemorrhagic pancreatitis). Overall mortality was 9.6%.

Conclusions:

• Biliary tract disease is a major cause of acute pancreatitis in this cohort.
• Emergency common duct decompression carries a significant mortality risk, necessitating careful patient selection.
• Exploration of the common bile duct and sphincteroplasty in the acute phase did not increase mortality, suggesting potential benefits in selected cases.