Experiences with the treatment of 42 patients with acute biliary pancreatitis

Introduction: Acute biliary pancreatitis (ABP) is one of the most severe complications of the biliary stone disease. Its contemporary management is early endoscopic papillotomy followed by stone extraction if necessary, and the best conservative treatment of pancreatitis.

Patients: During the last five years we have treated 42 patients (mean age: 64.5 /21–96/ years) with ABP. Thirty-seven pts had stones in the gallbladder, four had previous cholecystectomy and in one patient the gallbladder was stonefree. The severity of the pancreatitis was asessed by a modified Ranson score, and the majority of pts (26/42, 61.9%) had severe disease.

Methods: In case of suspected biliary origin of the pancreatitis we have performed duodenoscopy and if it was possible, ERCP and papillotomy followed by stone extraction was done. At the end of the procedure we inserted feeding tube into the second loop of the jejunum. At the first day we have administered saline, on the second day diluted nutrient and from the third day to definite healing we applied 1ml/kcal nutrient as continuous infusion into the jejunum.

Results: We performed 35 papillotomy, followed by stone extraction in 17 patients, and jejunal feeding was applied in 36 patients. The median time from the start of the symptoms to the intervention was 1 (1–21) day. The hospital stay was 11 (2–81) days in average. Two old patients died of pneumonia with healed pancreatitis and five died of complicated pancreatitis, all of them suffered from the severe form of the disease (mortality rate: 16.7%).

In summary: Besides the Ransone score the initial amylase value and the rate of the decrease also had prognostic value: high initial amylase and slow decrease was associated with poor outcome. Financial burden of the disease was always significant and became even more catastrophic nowadays.