Therapeutic approach and prevention in recurrent acute biliary pancreatitis

Abstract

OBJECTIVES: Acute biliary pancreatitis (ABP) is caused by alteration of the papillary patency. The normal transpapillar flux and the cleaning of the common biliary duct (CBD) may prevent potentially avoidable recurrent pancreatitis.

METHODS: In the period September 1997/December 2008 we have treated 224 ABP (34 severe, 190 mild/moderate): 162 (72,4%) with the first attack, 62 (27,6%) with recurrent ABP (second or further attack). The patients with recurrent pancreatitis had not undergone, in the previous hospital stay elsewhere, the evaluation and, if necessary, the treatment of the papillary obstacle and /or CBD stones, sludge, etc. In our hospital all patients had undergone the treatment of ABP. The treatment was completed with cholecystectomy. All the patients, after the discharge, were introduced in a follow-up program (clinical and ultrasonoghaphic (US) control after 180 days and 1 year).

RESULTS: In the follow-up of recurrent pancreatitis we have controlled 35 patients (56%-27 lost). The results of the follow-up showed, beside the absence of recurrent acute episodes, the stable normalization of laboratory cholestasis tests and US control. The same controls in 78 patients ( 48,1%) with a first attack of acute pancreatitis resulted normal in absence of a new acute episode.

CONCLUSIONS: Recurrent ABP have been caused by persistent papillary obstacle. Therefore we confirm therapeutic validity of the instrumental control (US/MRCP) and the possible treatment of papillary or biliary lithiasic obstacle for the prevention of recurrent ABP.