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World J Clin Cases. Nov 6, 2022; 10(31): 11292-11298
Published online Nov 6, 2022. doi: 10.12998/wjcc.v10.i31.11292
Surgical intervention for acute pancreatitis in the COVID-19 era
Yu-Jang Su, Tse-Hao Chen
Yu-Jang Su, Toxicology Division, Emergency Department, MacKay Memorial Hospital, Taipei 10449, Taiwan
Yu-Jang Su, Department of Medicine, MacKay Medical College, New Taipei 252, Taiwan
Yu-Jang Su, Department of Nursing, Yuanpei University of Medical Technology, HsinChu 300, Taiwan
Yu-Jang Su, Department of Nursing, MacKay Junior College of Medicine, Nursing, and Management, New Taipei 25245, Taiwan
Tse-Hao Chen, Emergency Medicine, MacKay Memorial Hospital, Taipei 10449, Taiwan
Author contributions: Su YJ was invited to make a review by the World Journal of Gastrointestinal Surgery; SU YJ and Chen TH gathered data, wrote the manuscript, and discussed it; Su YJ revised and corresponded.
Conflict-of-interest statement: We all declare there is no conflict of interest statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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 and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yu-Jang Su, MD, Assistant Professor, Director, Doctor, Teacher, Toxicology Division, Emergency Department, MacKay Memorial Hospital, No. 92 Sec 2, North Chung-Shan Road, Taipei 10449, Taiwan. yjsu.5885@mmh.org.tw
Received: July 11, 2022
Peer-review started: July 11, 2022
First decision: August 20, 2022
Revised: August 20, 2022
Accepted: September 20, 2022
Article in press: September 20, 2022
Published online: November 6, 2022
Abstract

Approximately 15%-19% of patients with severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infections develop gastrointestinal symptoms. Acute pancreatitis (AP) has been reported in 0.1% of patients with coronavirus disease 2019 (COVID-19). Biliary AP was most common (78.4%) before the COVID-19 pandemic; idiopathic AP is most common in patients with COVID-19 (up to 57.1%). The number of emergency department presentations decreased by 23.3% during the pandemic and many governments made national recommendations to delay nonurgent endoscopic procedures, leading to decrements of 22% in combined esophagogastroduodenoscopy (EGD) and colonoscopy and 20% in EGD after the COVID-19 pandemic. The symptoms and signs of COVID-19-related AP are fever (63%), abdominal pain (58%), respiratory symptoms (40%), nausea and vomiting (39%), and headache (4%). Approximately 5-10% of patients develop necrotizing or hemorrhagic AP, and patients who required surgical intervention had a higher mortality risk. Compared to 2019, the rates of elective surgery decreased by 41.8% in 2020; including cholecystectomy (40.1% decrease) and pancreas (111.1% decrease). Surgical volumes also decreased by 18.7% in 2020; device-assisted laparoscopic and robot-assisted procedures reduced by 45.4% and 61.9% during the COVID-19 Lockdown in 2020.

Keywords: 2019-nCoV, Complications, COVID-19, Pancreatitis, Surgery

Core Tip: Approximately 5%-10% of cases of acute pancreatitis (AP) develop necrotizing or hemorrhagic pancreatitis and require surgical intervention. Idiopathic causes were the leading etiology (57.1%) of coronavirus disease 2019 (COVID-19)-related AP. In COVID-19-related pancreatitis, gastrointestinal symptoms developed 1.7 days later than respiratory symptoms (9.0 d vs 7.3 d). Regarding examination of the pancreatitis, there was a 57.5% reduction in endoscopic retrograde cholangiopancreatography in 2020 compared to 2019. Moreover, COVID-19-related AP is associated with a 2.7-fold admission rate, 3.4-fold mortality rate, and 3-fold intensive care unit admission rate than non-COVID-19-related AP.