THERAPEUTIC APPROACH AND PREVENTION IN RECURRENT ACUTE BILIARY PANCREATITIS

Aim: 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. Patients and 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 ours hospital all patients had undergone complete treatment of ABP: intensive therapy, clinical: instrumental control of the papillary patency, then ERCP/ES(180-80%) within 72 hours from the onset in all SAP, in mild/moderate with signs of papillary lithiasic obstacle (US/MRCP confirmation), in all recurrent pancreatitis, and videolaparocholecystectomy. Results: In the follow-up of recurrent pancreatitis we have controlled, clinical and instrumental data, after 90 and 180 days, 35 patients (56%-27 lost): 21 SAP, 14 mild/moderate). Further recurrence only in 1 patients (2,8%); in the other controls recurrence of ABP are not reported; laboratory (amylases, cholestasis) and instrumental tests ( abdominal US) has been normal. Conclusions: Recurrent ABP have been caused, in the patients discharged from the hospital without additional treatment, by persistent papillary obstacle (small stones, sludge, cholesterol crystals, etc.). 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.