POSSIBILITIES OF MODERN METHODS OF INSTRUMENTAL DIAGNOSIS OF CLINICO-MORPHOLOGICAL FORMS OF CHRONIC PANCREATITIS

Abstract

Chronic pancreatitis is a serious disease of the pancreas, diagnosis of which remains difficult to date due to the difficulties in detecting early changes in the pancreas. Transabdominal ultrasound is regarded as the basic morphological diagnostic technique, but the sensitivity and specificity of the study is low. Additional methods for diagnosing pancreatic changes are computer tomography and endoscopic retrograde cholangiopancreatography. The purpose of our study was to study the possibilities of modern methods of instrumental diagnosis of clinical and morphological forms of chronic pancreatitis. Material: 210 patients with chronic pancreatitis were observed: I group - 26 obstructive patients, II - 56 calcifying, III - 78 patients with fibro-parenchymal form, IV - 50 patients with chronic pancreatitis complicated by pseudocyst. The structural state of the pancreas was studied by ultrasound, computed tomography and endoscopic retrograde cholangiopancreatography. The data obtained were evaluated according to the Cambridge criteria. The results demonstrate with ultrasound, computed tomography and endoscopic retrograde cholangiopancreatography revealed changes in the parenchyma and pancreatic ducts characteristic of chronic pancreatitis: an increase / decrease in the size of the pancreas, the presence of calcification in the ducts and parenchyma of the gland, pseudocyst and local parenchyma, enlargement / stenosis and the change in the contour of the main pancreatic duct and its connection with pseudocyst, the change in the structure of the parenchyma and the contours of the pancreas of the mammary gland. The majority of patients have severe structural changes in the pancreas, the highest frequency being determined in patients with a longer course of the disease (II - 75.0%, IV - 85.0%), somewhat less severe structural changes were detected in patients with a lesser history disease (I - 66.7%). To assess the sphincter of Oddi dysfunction, a diagnostic method has been developed, which consists in using the eufillin-calcium test with subsequent sonographic monitoring of the pancreatic duct system. A comparison was made between the data obtained with ultrasound, ERCP and CT and the sensitivity and specificity of each method was determined in the diagnosis of various forms of chronic pancreatitis. When comparing CT and ultrasound data, the following results were obtained: complete coincidence of diagnoses in 64.7% of cases, partial discrepancy of 28.5%, total discrepancy of 6.8%. Conclusions. For the diagnosis of chronic pancreatitis it is necessary to apply a complex of instrumental research. Usage of ultrasound has the highest sensitivity and specificity for calcifying (93,8% and 85,6%) and cystic (92,3% and 88,5%) forms of chronic pancreatitis, for the diagnosis of other forms of the disease, CT and ERCP should be used additionally. The developed non-invasive method for diagnosing the pathology of the sphincter of Oddi makes it possible to differentiate the presence of a mechanical obstruction in the duct of the gland with spasm of the sphincter.

Keywords

• chronic pancreatitis
• diagnostic methods