A Simple Clinical Classification System for Early Definitive Treatment Improves Quality of Care in Acute Biliary Pancreatitis

Abstract BackgroundThe complexity of acute biliary pancreatitis (ABP) regarding severity of pancreatitis, accompanying diseases in the biliary system, and the variety of available interventions have raised the need for individualized treatment. We aimed to develop a simple clinical classification system guiding early and definitive treatment in patients with ABP to improve quality of care. MethodsThe classification system for ABP was developed according to severity of disease, biliary obstruction, and common bile duct stone. 2951 patients (retrospective cohort) collected between June 2006 and July 2017 and 323 patients (prospective cohort, guided by the classification system) collected between August 2017 and May 2018 were used to compare quality of care: rate of early-definitive treatment and mortality. ResultsABP patients were divided into four classes: Type I, non-obstructive mild ABP; Type II, obstructive mild ABP; Type III, obstructive moderately severe/severe ABP; Type IV, non-obstructive moderately severe/severe ABP; each type was distributed into two subtypes: subtype a, accompanied by common bile duct stones; subtype b, without common bile duct stones. With the guidance by the classification system, the rate of early definitive treatments increased in Type I/II. Continuous regional arterial infusion was recommended as an early definitive treatment for patients with Type III/IV, in which the mortality has clearly descended. ConclusionsFor patients with ABP, we present a simple clinical classification system with 4 distinct types, with 2 subtypes for guiding the early-definitive treatment for ABP.