review of literature on clinical pancreatology - The Pancreapedia

was obtained in 7 <strong>of</strong> 8 patients (88 %) (3 transpapillary, 4 transgastric). On follow-up, clinicalimprovement was noted in 15 <strong>of</strong> 20 patients (70 %). For treatment <strong>of</strong> pain associated withchronic pancreatitis, pain scores decreased. Complications (in 2 <strong>of</strong> 20) included perforation(n=1) and respiratory failure (n=1). It was concluded that a single-operator EUS-guidedcholangiopancreatography provided decompression <strong>of</strong> obstructed ducts and may beperformed after a failed attempt at conventional ERCP during the same endoscopic session[202].Correlation between laboratory values and remaining common bile duct stoneAn important question to be answered in all cases <strong>of</strong> acute biliary pancreatitis is whether ornot a calculous biliary obstruction is still present. Answering this question conditionssubsequent management, include the need for endoscopic retrograde cholangiopancreatography(ERCP). The aim <strong>of</strong> one study was to determine the relationship between persistentcommon bile duct stone (CBDS) and laboratory values, and dilation <strong>of</strong> bile duct in order t<strong>of</strong>ind possible significant associations in patients with acute biliary pancreatitis (ABP). It wasretrospectively, statistical evaluated a group <strong>of</strong> 76 patients with ABP who had received earlyERCP. The prevalence <strong>of</strong> choledocholithiasis in patients > 70 years old was 54 percent, inpatients < 70 years old it was 37 percent. Following cholecystectomy, CBDS was present in82 percent <strong>of</strong> patients. The probability <strong>of</strong> CBDS occurrence in patients > 70 years old withbile duct dilation was 81 percent; in the absence <strong>of</strong> bile duct dilation CBDS was not present.The probability <strong>of</strong> CBDS occurrence in patients 70 years old with bile duct dilation was 58percent, in the absence <strong>of</strong> bile duct dilation CBDS was present in 15 percent, which was asignificant difference. In patients with bile duct dilation predictive factors were as follows:bilirubin, after excluding patients with acute cholecystitis and cholangitis; alanineaminotransferase in patients 70 years old; gamma-glutamyl transferase in patients > 70years old. It was concluded that ERCP is indicated in patients with acute biliary pancreatitis ifbiliary obstruction is present and the presence <strong>of</strong> a ductal stone is suspected. From theresults it is clear that the predictive parameter for choledocholithiasis is the dilation <strong>of</strong> the bileduct and previous cholecystectomy [203].Mild biliary pancreatitisGallstones represent the most common cause <strong>of</strong> acute pancreatitis in Sweden.Epidemiological data concerning timing <strong>of</strong> cholecystectomy and sphincterotomy in patientswith first attack <strong>of</strong> mild acute biliary pancreatitis (MABP) are scarce. Our aim was to analysereadmissions for biliary disease, cholecystectomy within one year, and mortality within 90days <strong>of</strong> index admission for MABP. Hospital discharge and death certificate data were linkedfor patients with first attack acute pancreatitis in Sweden 1988-2003. Mortality was calculatedas case fatality rate (CFR) and standardized mortality ratio (SMR). MABP was defined asacute pancreatitis <strong>of</strong> biliary aetiology without mortality during an index stay <strong>of</strong> 10 days orshorter. Patients were analysed according to four different treatment policies:Cholecystectomy during index stay (group 1), no cholecystectomy during index stay butwithin 30 days <strong>of</strong> index admission (group 2), sphincterotomy but not cholecystectomy within30 days <strong>of</strong> index admission (group 3), and neither cholecystectomy nor sphincterotomywithin 30 days <strong>of</strong> index admission (group 4). Of 11636 patients with acute biliary pancreatitis,8631 patients (74 %) met the criteria for MABP. After exclusion <strong>of</strong> those withcholecystectomy or sphincterotomy during the year before index admission (n=212), 8419patients with MABP remained for analysis. Patients in group 1 and 2 were significantlyyounger than patients in group 3 and 4. Length <strong>of</strong> index stay differed significantly betweenthe groups, from 4 (3-6) days, (representing median, 25 and 75 percentiles) in group 2 to 7(5-8) days in groups 1. In group 1, 4.9 percent <strong>of</strong> patients were readmitted at least once forbiliary disease within one year after index admission, compared to 100 percent in group 2, 63percent in group 3, and 76mpercent in group 4. One year after index admission, 31 percent<strong>of</strong> patients in group 3 and 48 percent <strong>of</strong> patients in group 4 had undergone cholecystectomy.SMR did not differ between the four groups. It was concluded that cholecystectomy duringindex stay slightly prolongs this stay, but drastically reduces readmissions for biliary