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Consensus definition of sludge and microlithiasis as a possible cause of pancreatitis

OBJECTIVE: In up to 20% of patients, the aetiology of acute pancreatitis (AP) remains elusive and is thus called idiopathic. On more detailed review these cases can often be explained through biliary disease and are amenable to treatment. Findings range from biliary sludge to microlithiasis but thei...

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Autores principales: Żorniak, Michal, Sirtl, Simon, Beyer, Georg, Mahajan, Ujjwal Mukund, Bretthauer, Katharina, Schirra, Jörg, Schulz, Christian, Kohlmann, Thomas, Lerch, Markus M, Mayerle, Julia
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10511955/
https://www.ncbi.nlm.nih.gov/pubmed/37072178
http://dx.doi.org/10.1136/gutjnl-2022-327955
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author Żorniak, Michal
Sirtl, Simon
Beyer, Georg
Mahajan, Ujjwal Mukund
Bretthauer, Katharina
Schirra, Jörg
Schulz, Christian
Kohlmann, Thomas
Lerch, Markus M
Mayerle, Julia
author_facet Żorniak, Michal
Sirtl, Simon
Beyer, Georg
Mahajan, Ujjwal Mukund
Bretthauer, Katharina
Schirra, Jörg
Schulz, Christian
Kohlmann, Thomas
Lerch, Markus M
Mayerle, Julia
author_sort Żorniak, Michal
collection PubMed
description OBJECTIVE: In up to 20% of patients, the aetiology of acute pancreatitis (AP) remains elusive and is thus called idiopathic. On more detailed review these cases can often be explained through biliary disease and are amenable to treatment. Findings range from biliary sludge to microlithiasis but their definitions remain fluid and controversial. DESIGN: A systematic literature review (1682 reports, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines) analysed definitions of biliary sludge and microlithiasis, followed by an online international expert survey (30 endoscopic ultrasound/hepatobiliary and pancreatic experts; 36 items) which led to definitions of both. These were consented by Delphi voting and clinically evaluated in a retrospective cohort of patients with presumed biliary pancreatitis. RESULTS: In 13% of original articles and 19.2% of reviews, microlithiasis and biliary sludge were used synonymously. In the survey, 41.7% of experts described the term ‘sludge’ and ‘microlithiasis’ as identical findings. As a consequence, three definitions were proposed, agreed on and confirmed by voting to distinctly discriminate between biliary sludge (hyperechoic material without acoustic shadowing) and microlithiasis (echorich calculi of ≤5 mm with acoustic shadowing) as opposed to larger biliary stones, both for location in gallbladder and bile ducts. In an initial attempt to investigate the clinical relevance in a retrospective analysis in 177 confirmed cases in our hospital, there was no difference in severity of AP if caused by sludge, microlithiasis or stones. CONCLUSION: We propose a consensus definition for the localisation, ultrasound morphology and diameter of biliary sludge and microlithiasis as distinct entities. Interestingly, severity of biliary AP was not dependent on the size of concrements warranting prospective randomised studies which treatment options are adequate to prevent recurrence.
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spelling pubmed-105119552023-09-22 Consensus definition of sludge and microlithiasis as a possible cause of pancreatitis Żorniak, Michal Sirtl, Simon Beyer, Georg Mahajan, Ujjwal Mukund Bretthauer, Katharina Schirra, Jörg Schulz, Christian Kohlmann, Thomas Lerch, Markus M Mayerle, Julia Gut Pancreas OBJECTIVE: In up to 20% of patients, the aetiology of acute pancreatitis (AP) remains elusive and is thus called idiopathic. On more detailed review these cases can often be explained through biliary disease and are amenable to treatment. Findings range from biliary sludge to microlithiasis but their definitions remain fluid and controversial. DESIGN: A systematic literature review (1682 reports, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines) analysed definitions of biliary sludge and microlithiasis, followed by an online international expert survey (30 endoscopic ultrasound/hepatobiliary and pancreatic experts; 36 items) which led to definitions of both. These were consented by Delphi voting and clinically evaluated in a retrospective cohort of patients with presumed biliary pancreatitis. RESULTS: In 13% of original articles and 19.2% of reviews, microlithiasis and biliary sludge were used synonymously. In the survey, 41.7% of experts described the term ‘sludge’ and ‘microlithiasis’ as identical findings. As a consequence, three definitions were proposed, agreed on and confirmed by voting to distinctly discriminate between biliary sludge (hyperechoic material without acoustic shadowing) and microlithiasis (echorich calculi of ≤5 mm with acoustic shadowing) as opposed to larger biliary stones, both for location in gallbladder and bile ducts. In an initial attempt to investigate the clinical relevance in a retrospective analysis in 177 confirmed cases in our hospital, there was no difference in severity of AP if caused by sludge, microlithiasis or stones. CONCLUSION: We propose a consensus definition for the localisation, ultrasound morphology and diameter of biliary sludge and microlithiasis as distinct entities. Interestingly, severity of biliary AP was not dependent on the size of concrements warranting prospective randomised studies which treatment options are adequate to prevent recurrence. BMJ Publishing Group 2023-10 2023-04-18 /pmc/articles/PMC10511955/ /pubmed/37072178 http://dx.doi.org/10.1136/gutjnl-2022-327955 Text en © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Pancreas
Żorniak, Michal
Sirtl, Simon
Beyer, Georg
Mahajan, Ujjwal Mukund
Bretthauer, Katharina
Schirra, Jörg
Schulz, Christian
Kohlmann, Thomas
Lerch, Markus M
Mayerle, Julia
Consensus definition of sludge and microlithiasis as a possible cause of pancreatitis
title Consensus definition of sludge and microlithiasis as a possible cause of pancreatitis
title_full Consensus definition of sludge and microlithiasis as a possible cause of pancreatitis
title_fullStr Consensus definition of sludge and microlithiasis as a possible cause of pancreatitis
title_full_unstemmed Consensus definition of sludge and microlithiasis as a possible cause of pancreatitis
title_short Consensus definition of sludge and microlithiasis as a possible cause of pancreatitis
title_sort consensus definition of sludge and microlithiasis as a possible cause of pancreatitis
topic Pancreas
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10511955/
https://www.ncbi.nlm.nih.gov/pubmed/37072178
http://dx.doi.org/10.1136/gutjnl-2022-327955
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