The 2023 MANCTRA Acute Biliary Pancreatitis Care Bundle: A Joint Effort Between Human Knowledge and Artificial Intelligence (ChatGPT) to Optimize the Care of Patients With Acute Biliary Pancreatitis in Western Countries.


Journal

Annals of surgery
ISSN: 1528-1140
Titre abrégé: Ann Surg
Pays: United States
ID NLM: 0372354

Informations de publication

Date de publication:
17 Jul 2023
Historique:
pubmed: 14 7 2023
medline: 14 7 2023
entrez: 14 7 2023
Statut: aheadofprint

Résumé

To generate an up-to-date bundle to manage acute biliary pancreatitis using an evidence-based, artificial intelligence (AI)-assisted GRADE method. A care bundle is a set of core elements of care that are distilled from the most solid evidence-based practice guidelines and recommendations. The research questions were addressed in this bundle following the PICO criteria. The working group summarized the effects of interventions with the strength of recommendation and quality of evidence applying the GRADE methodology. ChatGPT AI system was used to independently assess the quality of evidence of each element in the bundle, together with the strength of the recommendations. The seven elements of the bundle discourage antibiotic prophylaxis in patients with acute biliary pancreatitis, support the use of a full-solid diet in patients with mild to moderately-severe acute biliary pancreatitis, and recommend early enteral nutrition in patients unable to feed by mouth. The bundle states that ERCP should be performed within the first 48-72 hours of hospital admission in patients with cholangitis. Early laparoscopic cholecystectomy should be performed in patients with mild acute biliary pancreatitis. When operative intervention is needed for necrotizing pancreatitis, this should start with the endoscopic step-up approach. We have developed a new care bundle with seven key elements for managing patients with acute biliary pancreatitis. This new bundle, whose scientific strength has been increased thanks to the alliance between human knowledge and AI from the new ChatGPT software, should be introduced to emergency departments, wards, and ICUs.

Sections du résumé

OBJECTIVE OBJECTIVE
To generate an up-to-date bundle to manage acute biliary pancreatitis using an evidence-based, artificial intelligence (AI)-assisted GRADE method.
SUMMARY BACKGROUND DATA BACKGROUND
A care bundle is a set of core elements of care that are distilled from the most solid evidence-based practice guidelines and recommendations.
METHODS METHODS
The research questions were addressed in this bundle following the PICO criteria. The working group summarized the effects of interventions with the strength of recommendation and quality of evidence applying the GRADE methodology. ChatGPT AI system was used to independently assess the quality of evidence of each element in the bundle, together with the strength of the recommendations.
RESULTS RESULTS
The seven elements of the bundle discourage antibiotic prophylaxis in patients with acute biliary pancreatitis, support the use of a full-solid diet in patients with mild to moderately-severe acute biliary pancreatitis, and recommend early enteral nutrition in patients unable to feed by mouth. The bundle states that ERCP should be performed within the first 48-72 hours of hospital admission in patients with cholangitis. Early laparoscopic cholecystectomy should be performed in patients with mild acute biliary pancreatitis. When operative intervention is needed for necrotizing pancreatitis, this should start with the endoscopic step-up approach.
CONCLUSIONS CONCLUSIONS
We have developed a new care bundle with seven key elements for managing patients with acute biliary pancreatitis. This new bundle, whose scientific strength has been increased thanks to the alliance between human knowledge and AI from the new ChatGPT software, should be introduced to emergency departments, wards, and ICUs.

Identifiants

pubmed: 37450700
doi: 10.1097/SLA.0000000000006008
pii: 00000658-990000000-00562
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.

Déclaration de conflit d'intérêts

Conflicts of Interest and Source of Funding The authors report no conflict of interest. This research has not received any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Auteurs

Mauro Podda (M)

Department of Surgical Science, Emergency Surgery Unit, Cagliari State University Hospital, Cagliari, Italy.

Marcello Di Martino (M)

Division of Hepatobiliary and Liver Transplantation Surgery, A.O.R.N. Cardarelli, Naples, Italy.

Benedetto Ielpo (B)

Hepatobiliary Division, Hospital del Mar, Universitat Pompeu Fabra, Barcelona, Spain.

Fausto Catena (F)

Department of Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy.

Federico Coccolini (F)

General, Emergency and Trauma Surgery Unit, Pisa University Hospital, Pisa, Italy.

Francesco Pata (F)

Department of Surgery, Università della Calabria, Cosenza, Italy.

Giovanni Marchegiani (G)

Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, Department of Surgical, Oncological and Gastroenterological Sciences (DISCOG), University of Padua, Padua, Italy.

Belinda De Simone (B)

Department of Emergency and Metabolic Minimally Invasive Surgery, Centre Hospitalier Intercommunal de Poissy/Saint Germain en Laye, Poissy Cedex, France.

Dimitrios Damaskos (D)

Department of Upper GI Surgery, Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK.

Damian Mole (D)

Centre for Inflammation Research, Clinical Surgery, University of Edinburgh, Edinburgh, Scotland, UK.

Ari Leppaniemi (A)

Department of Abdominal Surgery, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland.

Massimo Sartelli (M)

Department of Surgery, Macerata Civil Hospital, Macerata, Italy.

Baohong Yang (B)

Department of Oncology, Weifang People's Hospital, The 1st Affiliated Hospital of Weifang Medical University, Weifang, Shandong, China.
Department of Gastroenterology, The 1st Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.

Luca Ansaloni (L)

General Surgery, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.

Walter Biffl (W)

Division of Trauma and Acute Care Surgery, Scripps Memorial Hospital La Jolla, La Jolla, CA, USA.

Yoram Kluger (Y)

General Surgery Department, Rambam Medical Center, Haifa, Israel.

Ernest E Moore (EE)

Denver Health System - Denver Health Medical Center, Denver, USA.

Gianluca Pellino (G)

"Luigi Vanvitelli" University of Campania, Naples, Italy.
Colorectal Surgery, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona UAB, Barcelona, Spain.

Salomone Di Saverio (S)

Department of Surgery, Madonna del Soccorso Hospital, San Benedetto del Tronto, Italy.

Adolfo Pisanu (A)

Department of Surgical Science, Emergency Surgery Unit, Cagliari State University Hospital, Cagliari, Italy.

Classifications MeSH