Experience in the treatment of acute pancreatitis of biliary etiology

The general characteristics of the methods and results of the treatment of acute pancreatitis of biliary etiology for the period from January 1, 2012 to December 31, 2021 are presented.

Patients with acute biliary pancreatitis are cared for based on the key principles of acute pancreatitis treatment of any other etiology – the long-term multicomponent intensive therapy aimed to relieve the syndrome of the systemic inflammatory response, to prevent multiple organ failure and infection of pancreatic necrosis foci, to refuse direct surgical interventions at the early stage of the disease, the reasonable use of minimally invasive draining interventions and the use of a regimen of repeated programmed operations to actively control all areas of necrotic destruction and infection to prevent the development of intra-abdominal complications.

Currently the key component of complex treatment of acute pancreatitis of biliary etiology is unanimously considered as the relief (conservative or surgical) of pancreatobiliary ductal hypertension.

Early laparoscopic cholecystectomy with choledochal drainage according to Halsted is a pathogenetically substantiated method of choosing the final treatment for acute biliary pancreatitis and should be performed regardless of the severity of the disease during the current hospitalization in all patients, as soon as their condition allows them to transfer the intervention.

Early laparoscopic cholecystectomy with choledochal drainage according to Halsted is a pathogenetically grounded method of choice of the definitive treatment of acute biliary pancreatitis etiology and should be carried out regardless of the disease severity in the period of the current hospitalization for all patients as soon as their state allows to survive the intervention.

Lethal outcomes at moderately severe and severe acute biliary pancreatitis are almost evenly distributed according to the terms (till/later than 2 weeks) after the disease beginning; their main cause is progressing multiple organ failure both in the aseptic course of the disease and at pancreatic necrosis infection.

1. Bagnenko, S.F. Hirurgicheskaya pankreatologiya / S.F. Bagnenko, A.A. Kurygin, G.I. Sinenchenko. – SPb.: Rech’, 2009. – 798 s.: il.

2. Voprosy hirurgicheskogo lecheniya ostrogo biliarnogo pankreati-ta / Z.E. El‘darova [i dr.] // RMZH. – 2022. – № 7. – S. 32–35.

3. Diagnostika i lechenie pacientov (vzrosloe naselenie) s ostrym pankreatitom pri okazanii medicinskoj pomoshchi v stacionarnyh uslo-viyah (klinicheskij protokol, utverzhden postanovleniem Ministerstva zdravoohraneniya Respubliki Belarus‘ ot 01.06.2017 g. № 46) [elektron-nyj resurs]. – Rezhim dostupa: http://minzdrav.gov.by/dadvfiles/001077_605253_46ost_h.pdf. – Data dostupa: 28.04.2023.

4. Differencirovannyj podhod k lecheniyu ostrogo biliarnogo pankreatita s ispol‘zovaniem miniinvazivnyh hirurgicheskih vmesha-tel‘stv / B.M. Belik [i dr.] // Dekabr‘skie chteniya po neotlozhnoj hirur-gii. T 11: Sb. nauchnyh trudov pod red. S.I. Tret‘yaka, I.M. Ladut‘ko – Mn.: BelMAPO, 2022. – S. 20–24.

5. Paskar‘, S.V. Patogeneticheskie podhody v lechenii biliarnogo pankreatita / S.V. Paskar‘ // Vestn. Ros. Voen.-med. akad. – 2010. – T. 3, № 31. – S. 78–83.

6. Savel‘ev, V.S. Ostryj pankreatit / V.S. Savel‘ev, M.I. Filimo-nov, S.Z. Burnevich // Klinicheskaya hirurgiya: nacional‘noe rukovodstvo: v 3 t. / pod red. V.S. Savel‘eva, A.I. Kirienko. – M.: GEOTAR-Media, 2009. – T. 2. – S. 196–228.

7. Hirurgicheskaya taktika pri ostrom biliarnom pankreatite / P.M. Nazarenko [i dr.] // Annaly hirurg. gepatologii. – 2011. – T. 16, № 4. – S. 71–76.

8. American College of Gastroenterology guideline: management of acute pancreatitis / S. Tenner [et al.] // Am. J. Gastroenterol. – 2013. – Vol. 108. – P. 1400–1415.

9. American Gastroenterological Association Institute Guideline on initial management of acute pancreatitis / S.D. Crockett [et al.] // Gastroenterol. – 2018 – Vol. 154. – P. 1096–101.

10. Carnovale, A. Mortality in Acute Pancreatitis: Is It an Early or a Late Event? / A. Carnovale, P.G. Rabitti, G. Manes // JOP. – 2005. – Vol. 6, № 5. – P. 438–444.

11. Classification of acute pancreatitis – 2012: revision of the Atlanta classification and definitions by international consensus / P.A. Banks [et al.] // Gut. – 2013. – Vol. 62. – P. 102–111.

12. Early Ductal Decompression Versus Conservative Management for Gallstone Pancreatitis With Ampullary Obstruction A Prospective Random-ized Clinical Trial / J.M. Acosta [et al.] // Ann. Surg. – 2006. – Vol. 243, № 1. – P. 33–40.

13. Early endoscopic retrograde cholangiopancreatography in predicted severe acute biliary pancreatitis: a prospective multicenter study / H.C. van Santvoort [et al.] // Ann. Surg. – 2009. – Vol. 250, № 1. – P. 68–75.

14. Freeman, M.L. Interventions for necrotizing pancreatitis: summary of a multidisciplinary consensus conference / M.L. Freeman, J. Werner, H.C. van Santvoort. International Multidisciplinary Panel of Speakers and Moderators // Pancreas. – 2012. – Vol. 41, № 8. – P. 1176–94.

15. Gallstone Pancreatitis: A Review / D. Cucher [et al.] // Surg. Clin. N. Am. – 2014. – Vol. 94. – P. 257–280.

16. Hu, C. Treatment strategy for gallstone pancreatitis and the timing of cholecystectomy / C. Hu, S-Q. Shen, Z-B. Chen // World J. Meta-Anal. – 2014. – Vol. 2, № 2. – P. 42–48.

17. IAP/APA evidence-based guidelines for the management of acute pan-creatitis / Working Group IAP/APA Acute Pancreatitis Guidelines // Pancrea-tology. – 2013. – Vol. 13. – P. 1–15.

18. Infection increases mortality in necrotizing pancreatitis: A systematic review and meta-analysis / M. Werge [et al.] // Pancreatology. – 2016. – Vol. 16, № 5. – P. 698–707.

19. Kaiser, A.M. Repetitive short-term obstructions of the common bile-pancreatic duct induce severe acute pancreatitis in the opossum / A.M. Kaiser, A.K. Saluja, M.L. Steer // Dig. Dis. Sci. – 1999. – Vol. 44, № 8. – P. 1653–1661.

20. Kao, L.S. Evidence-Based Management of Gallstone Pancreatitis / L.S. Kao, J.S. McCauley // Adv. Surg. – 2020 – Vol. 54. – P. 173–189.

21. Larson, S.D. Management of Gallstone Pancreatitis / S.D. Larson, W.H. Nealon, B.M. Evers // Adv. Surg. – 2006. – Vol. 40. P. 265–84.

22. Lerch, M.M. Gallstone-related pathogenesis of acute pancreatitis / M.M. Lerch, A.A. Aghdassi // Pancreapedia [Internet]. – 2016. – Available from: http:// dx.doi.org/10.3998/panc.2016.24.

23. Management of patients after recovering from acute severe biliary pancreatitis / G. Dedemadi [et al.] // World J. Gastroenterol. – 2016. – Vol. 22, № 34. – P. 7708–7717.

24. Optimal Timing and Outcomes of Minimally Invasive Approach in Acute Biliary Pancreatitis / M. Faur [et al.] // Med. Sci. Monit. – 2022. – 28: e937016-1–e937016-10.

25. Prevalence of Persistent Common Bile Duct Stones in Acute Biliary Pancreatitis Remains Stable Within the First Week of Symptoms / M.E. Fra-tantoni [et al.] // J. Gastrointest. Surg. – 2021. – Vol. 25, № 12. – P. 3178–3187.

26. Severe acute pancreatitis: overall and early versus late mortality in in-tensive care units / V. Bumbasirevic [et al.] // Pancreas. – 2009. – Vol. 38, № 2. – P. 122–5.

27. Timing of mortality in severe acute pancreatitis: Experience from 643 patients / C.-Y. Fu [et al.] // World J Gastroenterol. – 2007. – Vol. 13, № 13. – P. 1966–1969.

28. Tse, F. Early routine endoscopic retrograde cholangiopancreatography strategy versus early conservative management strategy in acute gallstone pancreatitis. (Review) / F. Tse, Y. Yuan // Cochrane Database Syst. Rev. – 2012. – Vol. 5. – CD009779.

29. Urgent endoscopic retrograde cholangiopancreatography is not supe-rior to early ERCP in acute biliary pancreatitis with biliary obstruction without cholangitis / H.S. Lee [et al.] // PLoS One. – 2018. – Vol. 13, № 2. – e0190835.

30. van Santvoort, H.C. A conservative and minimally invasive approach to necrotizing pancreatitis improves outcome / H.C. van Santvoort, O.J. Bak-ker, T.L. Bollen. Dutch Pancreatitis Study Group // Gastroenterol. – 2011. – Vol. 141, № 4. – P. 1254–63.