Prognostic significance of a set risk factors for acute pancreatitis after transpapillary interventions

The urgency of the problem: Pancreatitis is one of the most severe complications of transpapillary interventions. It is not always possible to predict the occurrence of pancreatitis. Mortality from this complication reaches 3%.  Research objective : To substantiate the prognostic significance of risk factors for the development of acute pancreatitis in patients undergoing transpapillary interventions. To establish the probability of complication development depending on a different combination of PEP risk factors. Materials and methods: 418 transpapillary interventions was performed on the base of NGHCI «Railway Clinical Hospital on Samara station OAO «RGHD» for 2 years. Acute pancreatitis was observed in 41 (9%) cases. Patients treated during the listed period were stratified into two groups: active treatment group (retrospective) and control group (prospective). Based on the analysis of the first patients group the following PEP were identified: female sex, young age, cholelithiasis, uneven cannulation of  MPD, atypical PST. It was found that patients didn’t have one isolated risk factor. A combination of various risk factors was observed in all cases. Prediction of acute pancreatitis by applying the selection of patients with a high risk of complications is used in practice at the control group. The sensitivity of the PEP predictive method on the basis of identifying a risk group, on the basis of a factors combination which affect on the complication development was 96.6%. The specificity of this method is 97.1%. Results:  The frequency of pancreatitis in the active treatment group and control group was 9% and 14% after ERCP performing. At the same time, the method of the determining the high risk of PEP, which was identified retrospectively, allowed predicting the complication development in most cases. Acute pancreatitis developed in 22 patients out of 27 who had a risk of developing this complication. Complex medicamentally prevention was performed for all patients with high risk of PEP. The group of patients most susceptible to the pancreatitis development which has the following combination of risk factors was selected: female sex, age from 20 to 40 years old, litoextraction with choledocholithiasis , atypical PST, cannulation of MPD. The risk of complications in a patient who has these risk factors is 88.8% according to our data. Conclusion: The identification of risk factors for the development of acute pancreatitis among patients undergoing transpapillary interventions allows to identify the group of patients most susceptible to complication. It allows starting a complex prevention of the complications development. Conservative prevention with Octreotide’s solution, infusion and antibacterial therapy is low-efficiency and does not reduce the risk of developing PEP. The introduction of other types of acute pancreatitis prevention, which have a more favorable effect and can prevent the pancreatitis development into clinical practice, is necessary.