SP 2.12 Spectrum and Determinants of Acute and Chronic Pancreatitis in Choledochal Cysts
Zeeshan Ahmed, Kislay Kany, Monish Karunakaran, Danesh Patel, Pradeep Rebala, G V RaoAbstract
Aims
Pancreatitis is a significant complication of Choledochal cysts (CDC). We aimed to investigate the burden of acute and chronic pancreatitis in pediatric and adult CDC cohorts along with their associated factors.
Methods
We conducted a retrospective cohort study of 654 consecutive patients who underwent choledochal cyst excision between July 2004 and July 2024 at a tertiary centre. Patients were classified as having acute pancreatitis (AP), chronic pancreatitis (CP), or no pancreatitis (NP) based on preoperative clinical, biochemical, and imaging criteria. Outcomes were compared between paediatric (<18 years) and adult (≥18 years) patients. Multivariate logistic regression was used to identify factors independently associated with AP and CP.
Results
Pancreatitis was present in 151 patients (23.1%), 93 (14.2%) with AP and 58 (8.9%) with CP. AP was significantly more frequent in pediatric patients (18.99% vs. 11.11%, p = 0.01), whereas the prevalence of CP did not differ by age. Adults had significantly higher duration of symptoms and biliary interventions. Patients with CP demonstrated higher rates of pancreas divisum and biochemical cholestasis. On multivariate analysis, adult age (≥18 years) was independently associated with a lower likelihood of AP (odds ratio [OR] 0.51, p < 0.01). CP was independently associated with pancreas divisum (OR 3.87, p < 0.01) and total bilirubin >4.0 mg/dL (OR 3.08, 95% CI 1.13-8.36, p = 0.03). Postoperative complication rates were comparable across pancreatitis phenotypes.
Conclusions
Pancreatitis complicates nearly one-quarter of CDC. Acute pancreatitis predominates in pediatric patients, whereas chronic pancreatitis is linked to pancreas divisum and significant cholestasis.