Treatment Of Biliary Pancreatitis Research Articles

Minimally-invasive technologies in the treatment of choledocholithiasis complicated by biliary pancreatitis

Minimal invasive endoscopic technologies are used in the treatment of patients with biliary pancreatitis with complicated cholangitis and biliary sepsis. 56 patients were treated for the period 2014 - 2018, aged 65.5 ± 15.18 years. ERCP was performed in 31 (55,3%) patients, in 13 (23,2%) - surgical intervention was performed without contrast of extrahepatic bile ducts. Papillotomy in 52 cases (96,4%) was performed by string papilloma and in 4 (7,1%) - by needle. In all cases, subtotal papilloprotectomy was performed [1], supplemented by balloon sphincteroplasty. In the I group, the patients included patients with biliary pancreatitis clinic, in group II patients with clinic of biliary sepsis, in the III group patients with purulent cholangitis clinic, biliary sepsis and septic shock. In the 1st and 2nd groups of patients, mortality was not observed. In the 3rd group, 3 patients died (37,5%). The rest of the patients are discharged from the hospital in a satisfactory condition. A decrease in the level of markers of hepatitis cytolysis (AlAT, AsAT, GGTP, L-FABP) was observed during surgical procedures without ERCP, indicating the toxic effect of contrast on the liver parenchyma. L-FABP is a highly informative marker for hepatocyte cytolysis and can be used as a criterion for hepatic insufficiency and prognosis of biliary sepsis. The high efficiency of transpacillary endoscopic surgical techniques in the treatment of biliary pancreatitis and biliary sepsis was noted.

Hymecromone Efficacy in the Treatment of Biliary Pancreatitis

Aim. To study the contribution of biliary sludge (BS) to the development of chronic pancreatitis in patients with gallbladder sludge and verified chronic pancreatitis; to evaluate the clinical efficacy and safety of hymecromone therapy according to clinical and laboratory signs, as well as dynamics of gallbladder size and contractility.Materials and methods. An open single-centre clinical trial included 30 patients with chronic pancreatitis (CP), which was diagnosed according to the Cambridge criteria. All patients received hymocromone (Odeston®) 400 mg tid for 3 weeks. An analysis of the efficacy and safety of the studied drug was performed on the 21st day of treatment based on the results of laboratory tests, abdominal ultrasound, cholecystography and endosonography of the pancreatobiliary zone, quality-of-life assessment according to the SF-36 questionnaire, the frequency and severity of adverse effects (AE).Results. CP signs were found in 6.3 % of patients with gallbladder BS. CP was significantly more frequent in patients with putty-like bile (33.3 %, χ2 = 38.21, p < 0.00001). The area of the major duodenal papilla (MDP) was below normal in 78% of patients. According to factor analysis, monotherapy with hymocromone resulted in a decrease in abdominal pain, nausea, heaviness in the abdomen and bloating. By the end of the therapy, the quality of life according to the “BP” bodily pain scale of the SF-36 questionnaire significantly increased.Conclusions. Biliary sludge (including undiagnosed forms during routine examination) was found to be a factor in the development of CP. The medical correction of biliary disorders in CP should include selective antispasmodics. Hymecromone therapy demonstrates a good level of tolerability and safety, normalizes the motor function of the biliary tract and sphincter tone over a short period of time, and relieves CP symptoms.

The calcium-activated phosphatase calcineurin is a potential drug target for the treatment of biliary pancreatitis

The calcium-activated phosphatase calcineurin is a potential drug target for the treatment of biliary pancreatitis

BACTERIOLOGIC ANALYSIS OF BILE IN CHOLELITHIASIS PATIENTS WITH AND WITHOUT ACUTE PANCREATITIS

In animals, bacterial infection of bile is essential for the induction of acute biliary pancreatitis (ABP), the severity of which is species-dependent. It is unknown whether this phenomenon is applicable to the human pancreas and therefore we have investigated the microbiology of bile in ABP patients. Methods and Results: From 205 ABP patients bile samples were collected during surgery and submitted to bacteriologic examination. There were 107 (52,2%) patients with negative bile cultures and 98 (47,8%) with positive cultures. The microbiology results of these 98 patients were compared with those of 98 control patients with symptomatic cholelithiasis but without pancreatitis. A total number of 178 microorganisms were isolated in both groups. In the ABP patients 17 (9.5%) obligate anaerobes were isolated versus (vs.) 22 (12,4%) in the control patients (p = 0,396). Eighty-five (47,8%) Gram-positive aerobes were found in the study group vs. 50 (28,1%) in the control group (p < 0,001). There were 76 (42,7%) Gram-negative pathogens in the ABP patients vs. 106 (59,6%) in the controls (p = 0,001). Twice as many streptococci and three times more staphylococci were cultured in the pancreatitis group. Conclusion: The high percentage negative bile cultures suggests that bile infection is not mandatory for the induction of human ABP. If infected, Gram-positives are the prevalent microoganisms and this might have implications in both the pathophysiology and the treatment of biliary pancreatitis.

Tratamento cirúrgico postergado da pancreatite aguda biliar

A análise do tratamento cirúrgico de doentes portadores de pancreatite biliar mostra a existência de controvérsias em relação à oportunidade da intervenção, principalmente se deve ser precoce ou postergada. Do mesmo modo, a possibilidade do emprego de procedimentos endoscópicos no pré, intra ou pós-operatório e o advento da videolaparoscopia, trouxeram novos aspectos à discussão. Não existe consenso sobre a escolha da melhor conduta. Em função disso, analisamos retrospectivamente os resultados imediatos de 107 doentes portadores de forma leve de pancreatite, todos com menos de três sinais de gravidade, segundo o critério de estratificação proposto por Ranson, e que foram submetidos ao tratamento cirúrgico postergado na mesma internação, no período de janeiro de 1988 a maio de 1999, tanto por via convencional como por via laparoscópica. Desses, 80 doentes (75%) eram do sexo feminino, 90% da raça branca e a média de idade foi de 46 anos. Os doentes foram operados em média após 9,5 dias de internação e receberam alta hospitalar após 2,9 dias, o que resultou numa permanência hospitalar média de 12,6 dias. A colangiografia intra-operatória foi realizada em 102 casos (96%) e a colangiografia endoscópica pré-operatória em 24 doentes (22,4%). Os resultados mostraram incidência de coledocolitíase em 25 casos (23%), taxa de morbidade de 12% e mortalidade nula. Dos 107 casos estudados, 64 (60%) foram operados pela via de acesso convencional e 43 (40%) pela via laparoscópica. A comparação dos resultados entre as vias de acesso empregadas mostrou diferença estatística significante em relação ao intervalo de tempo pós-operatório, que foi menor nos doentes submetidos à via de acesso laparoscópica. Concluímos, assim, que o tratamento cirúrgico postergado de doentes portadores de pancreatite biliar na forma leve apresenta baixas morbidade e mortalidade e pode ser feito tanto pela via convencional como pela via laparoscópica. A presença de coledocolitíase, nesta casuística, não contribuiu para aumentar os índices de complicações pós-operatórias e nem a mortalidade.

Acute pancreatitis. Early elective endoscopic intervention

Early endoscopic intervention is required in the treatment of biliary pancreatitis in the presence of cholangitis or jaundice, possibly with dilated common bile duct. Also patients with predicted severe disease, lack of spontaneous clinical improvement or progressive jaundice might benefit from endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy. If endoscopy is indicated, it should be performed as soon as possible. Injection of contrast medium into a dilated bile duct is accompanied by the risk of cholangitis. Therefore therapeutic decompression by sphincterotomy and stone extraction is necessary, or, if this is not possible, insertion of a naso-biliary tube for drainage. Prophylactic use of antibiotics is recommended periinterventionally. Early endoscopic intervention is not necessary in patients with mild biliary pancreatitis and spontaneous clinical improvement. Here, ERCP can be performed later, if indicated.