DIAGNOSTIC MARKERS OF ACUTE CHOLANGITIS IN BILIARY PANCREATITIS IN PATIENTS WITH IMPACTED STONES OF THE MAJOR DUODENAL PAPILLA

Abstract

Purpose: оbjectivize the diagnostic criteria of acute cholangitis in acute obturational biliary pancreatitis.Materials and methods: a retrospective analysis of the treatment of 90 patients with a wounded OBD stone after ECST was performed. To diagnose and assess the severity of acute cholangitis in the preoperative period, the diagnostic criteria of theTokyo classification of 2013 (TG13) were used. Endoscopic diagnosis of acute cholangitis was established during ESTT in visual assessment of bile, the presence of edema, hyperemia, fibrin deposits in the distal bile duct. A comparative analysis of laboratory-instrumental parameters before and aft er EPST in patients with acute cholangitis depending on the degree of severity according to TG13, and in patients with or without endoscopic signs of cholangitis was performedResults: according to TG13, acute cholangitis was diagnosed in all patients. An easy degree was established in 31 patients (34.4%), moderate in 53 (58.9%), severe in 6 (6.7%). Th e markers of systemic infl ammation had an upward character depending on the degree of severity of the cholangitis, the tendency of decrease and the normalization time aft er EPST directly correlated with the initial parameters in the groups (r = 0.728, p = 0.000). Laboratory indices of cholestasis were of an upward character in patients with mild to moderate cholangitis, which was refl ected both in the ultrasoundographic imaging of the bile ducts upon admission and in the data of cholangiography with EPST (p <0.05). Th e levels of transaminase and amylase did not have statistically significant diff erences (p> 0.05).Endoscopic signs of cholangitis were revealed in 44 (48.9%) patients. When comparing the ratio between patients who had endoscopic cholangitis signs and severity, according to TG13, in 11 (35.5%) acute cholangitis was classified as easy, in 30 (56.6%) as average, in 3 (6.8%) as (P = 0.174) and the correlation between endoscopic signs and severity of cholangitis was not noted (r = 0.162 p = 0.126). In the comparative analysis of laboratory-instrumental parameters of patients, no statistically significant diff erences were found (p> 0.05), depending on the presence or absence of endoscopic signs of cholangitis.Conclusions: diagnostic criteria of acute cholangitis TG13 are applicable for the preliminary diagnosis of acute cholangitis in conditions of acute biliary pancreatitis and can serve as an indication for a timely EPST.

Keywords

• impacted stone of major duodenal papilla
• acute obturational biliary pancreatitis
• acute cholangitis