EVALUATION OF PREDICTORS OF THE COURSE OF ACUTE GALLSTONE PANCREATITIS

The diagnostic efficiency of emergency esophagogastroduodenoscopy (EGD) and the use of parapapillary block in evaluation of severity of the course of acute gallstone pancreatitis (AGP) for the first day were analyzed. The study involved 100 patients with AGP. The main entry criterion for patients was the diagnosis of acute gallstone pancreatitis and symptoms of biliary hypertension. Patients were divided into two groups: 50 patients, for whom the severity of the AGP course was evaluated by the APACHE II score (control group), and 50 patients, for whom the severity of disease was evaluated with the use of the parapapillary block (index group). In the age, sex, duration of disease, comorbidity, and causes of disease, the index group was identical to the control group (p > 0.05). In collected anamnestic data, 84 patients (84%) reported diet violation (eating of rich food). In the clinical picture, the pain syndrome predominated. In clinical-laboratory tests, predictors of acute pancreatitis were found in 94% of patients: increased amylases level in 100% of cases, increased lipase level in 64 patients (64%), decreased blood sugar level in 26 patients (26%), increased blood sugar level in 17 patients (17%), increased bilirubin level in 29 patients (29%), and jaundice in 9 patients (9%). EGD revealed increased stomach tone in 32 patients (32%), increased bile amount in stomach in 52 patients (52%), hemorrhages and erosions in the postbulbar duodenum with predominant lesion of the posterior wall in 68 patients (68%), changed duodenal angle in 12 patients (12%), papillitis in 43 patients (43%), and bile outflow rhythm disorder (r = 0.88, р = 0.00012) in 36 patients (36%). Conclusions: The absence of effect from parapapillary block allows one to speak about the severe course of acute gallstone pancreatitis. The proposed method allows physicians to evaluate the severity of acute pancreatitis and to prescribe the adequate start therapy.

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