OBJECTIVE
The aim of the study was to develop a tool for objective assessment of the risk of acute postmanipulatory pancreatitis (OPMP) after endoscopic interventions based on an analysis of the treatment results of 154 patients with choledocholithiasis.
MATERIAL AND METHODS
Based on the correlation analysis of treatment results, the main risk factors that play an important role in the development of OPMP were identified: age (less than 50 years) — with an increase in the predictor value by 1, the probability of developing OPMP decreases by 1%; overweight (body mass index—BMI more than 26 kg/m2) — an increase by one increases the probability of developing OPMP by 12%; macroscopic type of PF: type I according to Haraldsson — the probability of developing OPMP is lower by 51%; macroscopic type of PF: type II—III—IV according to Haraldsson — the probability of developing OPMP is higher by 28%; the need for stenting of the common bile duct (CBD) — the probability of developing OPMP is higher by 208%; the time of cannulation of CBD until the moment of transition to taking «precut» is more than 5 minutes (the time of contact of the instrument with the mouth of the PF) — the probability of developing OPMP is higher by 156%; cannulation followed by stenting of the MPD — the probability of developing OPMP is reduced by 88%; the diameter of the CBD is more than 10 mm according to the preoperative MRCP/CT — an increase by one reduces the likelihood of developing OPMP by 6.6%; the diameter of the stones in the CBD is more than 15 mm according to preoperative MRCP/CT—an increase of one increases the probability of developing OPMP by 11%.
RESULTS
To determine the risk of developing OPMP, a point—prognostic scale was developed based on the results of processing correlation analysis data using the inverse logistic regression method: Age less than 50 years — 2 points; Body mass index: less than 26 — 0 points, 26—31 — 1 point, more than 31 — 2 points; Type I PF according to Haraldsson according to the redoperative duodenoscopy — 1 point; PF types II—III—IV according to Haraldsson, according to preoperative duodenoscopy — 2 points; Intradiverticular location of the mouth of the PF — 3 points; Mechanical jaundice — hyperbilirubinemia of more than 50 mmol/l (as an indication for surgery) —1 point; «Difficult» cannulation and switching to «precut» for no more than 5 minutes after instrument contact with PF — 2 points; «Difficult» cannulation and switching to «precut» for more than 5 minutes after the instrument came into contact with the PF — 3 points; The need for stenting of the CBD — 3 points; Unintentional cannulation of the MPD followed by its stenting — 2 points; The diameter of the CBD is less than 10 mm according to preoperative MRCP/CT — 2 points; CBD — stones are more than 15 mm in diameter according to the preoperative MRCP — 3 points.
The result was evaluated by summing up the scores obtained according to the data obtained: 0—5 points — low probability of developing acute postmanipulatory pancreatitis; 6—11 points — moderate probability of developing acute postmanipulatory pancreatitis; 12 or more points — high probability of developing acute postmanipulatory pancreatitis.
CONCLUSIONS
When planning transpapillary endoscopic interventions in patients with choledocholithiasis, risk factors for the development of acute postmanipulatory pancreatitis should be taken into account. Taking into account these factors and the use of a point-prognostic scale makes it possible to stratify patients taking into account the likelihood of developing acute postmanipulatory pancreatitis and to provide differentiated perioperative support aimed at preventing pancreatitis.
