S271 The Efficacy and Safety of Microbiome Modulating Agents Alongside Standard Management for Acute Pancreatitis: An Updated Systematic Review and Network Meta-Analysis

Introduction: Obese patients are at increased risk of developing severe acute pancreatitis (AP) with increased complication morbidities including pancreatic necrosis and intensive care unit admission. Bariatric surgery was reported to reduce mortality among AP patients in the United States inpatient database. We aimed to evaluate whether the benefit from prior bariatric surgery applies to a broader population. Methods: We conducted a retrospective cohort study using de-identified TriNetX database, which includes data on over 179 million individuals globally, from January 1, 2015, to January 1, 2025. Adult patients (≥18 years) with a diagnosis of AP and BMI ≥40 kg/m² were divided into 2 cohorts based on the presence or absence of sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) history performed at least 6 months prior to AP diagnosis. Propensity score matching (1:1) was performed to adjust for demographics and confounders. Kaplan-Meier survival analysis and univariate Cox proportional hazards models were used to assess the incidence of the primary outcome (mortality) and secondary outcomes, including acute renal failure, respiratory failure, necrotizing pancreatitis, sepsis, septic shock, and need for surgical drainage of pancreatic fluid collections at 2 weeks, 1 month, and 3 months after AP diagnosis, based on the revised Atlanta classification. Results: Among 2,798 patients with prior SG and RYGB and 47,999 without, PSM yielded 2,792 matched pairs. Patients with prior SG or RYGB were younger (mean age 51.1 ± 13 years vs 53.3 ± 16.5 years, P < 0.001) and more likely to be women (75% vs 59%, P < 0.001). After matching, patients with prior SG or RYGB had significantly lower odds of acute respiratory failure at 2 weeks (odds ratio 0.581, P = 0.002) and 1 month (odds ratio 0.623, P = 0.003). No significant differences were observed in mortality, acute kidney failure, or necrotizing pancreatitis at all time points. The rates of sepsis, septic shock, and mortality tended to be lower in the SG or RYGB group without statistical significance. Conclusion: History of SG or RYGB decreased the risk of acute respiratory failure among obese patients within 1-month post-AP diagnosis based on this large cohort analysis. These findings suggest the history of SG or RYGB may serve as a protective factor against systemic complications of AP.

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