Optimal Timing and Outcomes of Minimally Invasive Approach in Acute Biliary Pancreatitis

Background We analyzed the outcomes of early biliary decompression by a minimally invasive approach in acute biliary pancreatitis (ABP). Material/Method A retrospective study was conducted on 143 patients with ABP who underwent biliary decompression by laparoscopic or endoscopic approach between January 2015 and March 2022. Data from the observation sheets and surgical protocols were analyzed in terms of demographic characteristics, clinical and paraclinical features at admission, comorbidities, therapeutic management, and outcomes. Results The mean patient age was 62.3±11.4 years. Mild ABP had a higher frequency in men (75.5%) and urban areas (70.4%). The comorbidities associated with a higher risk of severe forms were diabetes mellitus (odds ratio [OR]: 11.250), chronic bronchopneumopathy (OR: 29.297), and ischemic coronary disease (OR: 2.784). The mean hospital stay was 7.6±3.8 days and was significantly higher in severe forms (10±2.4 days, P<0.001). The time from onset to presentation was significantly higher in severe vs mild forms (5.6 vs 1.8 days, P<0.001) and was associated with systemic and local complications. Creatinine over 2 mg/dL (OR: 4.821) and leukocytes >15 000/mmc at admission (OR: 3.533) were risk factors for systemic complications, while obesity was associated with increased local complications (OR: 5.179). None of the patients with an early presentation developed severe ABP. Conclusions Early biliary decompression, as soon as possible after onset, either by an endoscopic or minimally invasive approach, is a safe and effective procedure in ABP. The type of procedure and optimal timing should be individualized, according to the patient’s local and general features.

[1]  S. Réhman,et al.  C-Reactive Protein as a Predictor of Complicated Acute Pancreatitis: Reality or a Myth? , 2021, Cureus.

[2]  D. Serban,et al.  Acute surgical abdomen during the COVID-19 pandemic: Clinical and therapeutic challenges. , 2021, Experimental and therapeutic medicine.

[3]  S. Regnér,et al.  The Initial Course of IL1β, IL-6, IL-8, IL-10, IL-12, IFN-γ and TNF-α with Regard to Severity Grade in Acute Pancreatitis , 2021, Biomolecules.

[4]  F. Vleggaar,et al.  Urgent endoscopic retrograde cholangiopancreatography with sphincterotomy versus conservative treatment in predicted severe acute gallstone pancreatitis (APEC): a multicentre randomised controlled trial , 2020, The Lancet.

[5]  A. Abrantes,et al.  Evaluation of Prognostic Factors of Severity in Acute Biliary Pancreatitis , 2020, International journal of molecular sciences.

[6]  V. Ellenrieder,et al.  Management of Severe Acute Pancreatitis: An Update , 2020, Digestion.

[7]  A. Arj,et al.  Optimizing cholecystectomy time in moderate acute biliary pancreatitis: A randomized clinical trial study , 2020, Heliyon.

[8]  Vikesh K. Singh,et al.  Worldwide Variations in Demographics, Management, and Outcomes of Acute Pancreatitis. , 2019, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[9]  Wen-feng Huang,et al.  The optimal timing of laparoscopic cholecystectomy in patients with mild gallstone pancreatitis , 2019, Medicine.

[10]  Ari Leppäniemi,et al.  2019 WSES guidelines for the management of severe acute pancreatitis , 2019, World Journal of Emergency Surgery.

[11]  M. Bilal,et al.  Evaluation and management of acute pancreatitis , 2019, World journal of clinical cases.

[12]  Hai-Bo Xu,et al.  Current concepts for the diagnosis of acute pancreatitis by multiparametric magnetic resonance imaging. , 2019, Quantitative imaging in medicine and surgery.

[13]  Yelan Guo,et al.  Moderately severe and severe acute pancreatitis : a systematic review of the outcomes in the USA and European Union-5 , 2019, BMJ open gastroenterology.

[14]  H. Yasunaga,et al.  Early prophylactic antibiotics for severe acute pancreatitis: A population-based cohort study using a nationwide database in Japan. , 2018, Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy.

[15]  S. Tenner,et al.  Fluid Collections and Pseudocysts as a Complication of Acute Pancreatitis. , 2018, Gastrointestinal endoscopy clinics of North America.

[16]  Shilpa Rao,et al.  Interleukin-6: An Early Predictive Marker for Severity of Acute Pancreatitis , 2017, Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine.

[17]  Hong-zhao Li,et al.  Prognostic value of a systemic inflammatory response index in metastatic renal cell carcinoma and construction of a predictive model , 2016, Oncotarget.

[18]  A. Saluja,et al.  Role of trypsinogen activation in genesis of pancreatitis , 2016 .

[19]  J. Louhimo,et al.  Necroptosis Is an Important Severity Determinant and Potential Therapeutic Target in Experimental Severe Pancreatitis , 2016, Cellular and molecular gastroenterology and hepatology.

[20]  N. Avenia,et al.  Necrotizing pancreatitis: A review of the interventions. , 2016, International journal of surgery.

[21]  M. Serinken,et al.  Pain treatment in patients with acute pancreatitis: A randomized controlled trial. , 2016, The Turkish journal of gastroenterology : the official journal of Turkish Society of Gastroenterology.

[22]  S. Novovic,et al.  Spectrum of microorganisms in infected walled-off pancreatic necrosis - impact on organ failure and mortality. , 2014, Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.].

[23]  H. Algül,et al.  Early phase of acute pancreatitis: Assessment and management. , 2014, World journal of gastrointestinal pathophysiology.

[24]  P. Reddy,et al.  Laparoscopic necrosectomy in acute necrotizing pancreatitis: Our experience , 2014, Journal of minimal access surgery.

[25]  Sylvie Chevret,et al.  Effects of fluid resuscitation with colloids vs crystalloids on mortality in critically ill patients presenting with hypovolemic shock: the CRISTAL randomized trial. , 2013, JAMA.

[26]  D. Whitcomb,et al.  Genetics of acute and chronic pancreatitis , 2013, Current opinion in gastroenterology.

[27]  P. Fockens,et al.  Lack of Consensus on the Role of Endoscopic Retrograde Cholangiography in Acute Biliary Pancreatitis in Published Meta-Analyses and Guidelines: A Systematic Review , 2013, Pancreas.

[28]  O. Aslan,et al.  Hepcidin as a predictor of disease severity in acute pancreatitis: a single center prospective study. , 2013, Hepato-gastroenterology.

[29]  H. Goor,et al.  IAP/APA evidence-based guidelines for the management of acute pancreatitis. , 2013, Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.].

[30]  K. Horvath,et al.  Interventions for Necrotizing Pancreatitis: Summary of a Multidisciplinary Consensus Conference , 2012, Pancreas.

[31]  Yuhong Yuan,et al.  Early routine endoscopic retrograde cholangiopancreatography strategy versus early conservative management strategy in acute gallstone pancreatitis. , 2012, The Cochrane database of systematic reviews.

[32]  R. Thoeni.  The revised Atlanta classification of acute pancreatitis: its importance for the radiologist and its effect on treatment. , 2012, Radiology.

[33]  P. Garg,et al.  Intra-acinar trypsinogen activation mediates early stages of pancreatic injury but not inflammation in mice with acute pancreatitis. , 2011, Gastroenterology.

[34]  J. Neoptolemos,et al.  Minimal Access Retroperitoneal Pancreatic Necrosectomy: Improvement in Morbidity and Mortality With a Less Invasive Approach , 2010, Annals of surgery.

[35]  C. Dervenis,et al.  Imaging evaluation of post-pancreatitis infection. , 2010, Infectious disorders drug targets.

[36]  I. A. Al Mofleh.  Severe acute pancreatitis: pathogenetic aspects and prognostic factors. , 2008, World journal of gastroenterology.

[37]  S. Sargent.  Pathophysiology, diagnosis and management of acute pancreatitis. , 2006, British journal of nursing.

[38]  Masahiko Hirota,et al.  The role of trypsin, trypsin inhibitor, and trypsin receptor in the onset and aggravation of pancreatitis , 2006, Journal of Gastroenterology.

[39]  B. Rau,et al.  Role of early multisystem organ failure as major risk factor for pancreatic infections and death in severe acute pancreatitis. , 2006, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[40]  V. Subbotin,et al.  Acute Pancreatitis and Bacterial Translocation , 2001, Digestive Diseases and Sciences.

[41]  W. Bechstein,et al.  [Acute pancreatitis]. , 2004, Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen.

[42]  J. Norman.  The role of cytokines in the pathogenesis of acute pancreatitis. , 1998, American journal of surgery.

[43]  P. Laterre,et al.  Severe acute pancreatitis: pathophysiologic mechanisms underlying pancreatic necrosis and remote organ damage. , 1996, Acta gastro-enterologica Belgica.

[44]  G. Nardi,et al.  DIAGNOSIS AND MANAGEMENT OF ACUTE PANCREATITIS. , 1965, Postgraduate medicine.