ENDOSCOPIC PAPILLOSPHINCTEROTOMY IN ACUTE BILIARY PANCREATITIS AS PREVENTION AND TREATMENT POSTCHOLECYSTECTOMICAL SYNDROME
The aim of this study was to evaluate the morphological changes in the duodenum at acute biliary pancreatitis and after cholecystectomy and their influence on the frequency of EPST use at acute biliary pancreatitis. Materials and methods. Multicentre cohort study. A retrospective analysis of medical records of 535 patients with proven biliary pancreatitis from 2007 to 2013. Men - 212 (39.63%), 323 women (60.37%). The average age of 54,83 ± 14,17. The prospective study in 2013-2015 included similar 100 patients, mean age 59,27 ± 16,66 years. Duodenoscopy performed in all patients during the first 4 days. All of these patients underwent biopsy of duodenal mucosa near the papilla Vater. For comparison, 34 morphological studies performed of zone papilla Vater in patients with cholelithiasis after papillotomy. 28 women (82.3%), 6 males (17.7%) aged 25 to 82 years. Statistical analysis performed using the software Statistica 6.0 and SPSS19.0 Results. Frequency of EPST at acute biliary pancreatitis was 16.9%. In a retrospective analysis of the most significant causes of EPST were papillitis (φ = 0,950), functional stenosis of papilla (φ = 0,643), cicatrical stenosis of papilla (φ = 0,299) and obstruction of papilla by stone (φ = 0,299). In a prospective study dominated cicatrical stenosis of papilla (φ = 0,783) and obstruction of papilla by stone (φ = 0,446). Morphological studies of duodenal mucosa showed significant dependence of expression of morphological changes from the severity of acute biliary pancreatitis. Morphological assessment of papillae revealed the prevalence of chronic inflammatory changes, but the frequency of involvement in the inflammation of the deep layers were similar (18% vs. 15%). Conclusion. Frequency of duodenal inflammatory changes and inflammatory changes of papilla are connected among themselves. Endoscopic signs of duodenitis and papillit with expansion of a longitudinal fold demand early correction.