Acute biliary pancreatitis: severity criteria, role of biliary sludge, treatment

Aim. To investigate the severity criteria of acute biliary pancreatitis in various causes of bile outflow obstruction into the duodenum, including biliary sludge, and to analyze the treatment outcomes of patients.

Materials and methods. A retrospective analysis was conducted on the diagnostic and treatment results of 89 patients with a confirmed cause of obstruction of the common bile duct following endoscopic papillosphincterotomy. The severity of pancreatitis was assessed in terms of organ failure, pancreatic necrosis, and the severity of cholangitis. The presence of sludge in the gallbladder was evaluated by means of ultrasound, and papillitis was assessed during esophagogastroduodenoscopy.

Results. In Group 1, 23 patients had biliary sludge as the cause of bile outflow obstruction; in Group 2 (n = 32), the cause lied in an impacted stone; and in Group 3 (n = 34), in choledocholithiasis. Organ failure was noted in 11 patients of group 1, in 13 patients of group 2, and in 7 patients of group 3 (p < 0.04). In group 1, organ failure occurred against the background of pancreatic necrosis (n = 7) and acute cholangitis (n = 4); in group 2, all 13 patients exhibited acute cholangitis (p < 0.05). The proportion of patients with papillitis was significantly higher in Groups 1 and 2. Sludge in the gallbladder was detected in 14 patients of Group 1, 4 patients of Group 2, and 8 patients of Group 3 (p < 0.001). Nasobiliary drainage after endoscopic papillosphincterotomy was applied in 34 cases, pancreatic duct stenting in 33 cases, and invasive interventions for peripancreatitis in 9 cases. 3 patients (3.4%) died.

Conclusion. Pancreatic necrosis and acute cholangitis determined the severity of acute biliary pancreatitis, which is consistent with the concept of 2 types of disease – pancreatic and biliary. Biliary sludge in the bile duct, alongside impacted stones, caused bile duct obstruction in patients with organ failure. Sludge in the gallbladder and papillitis, along with signs of biliary hypertension, suggest its presence in the common bile duct and indicates the need for endoscopic papillosphincterotomy. The identified patterns appear relevant and may be considered in protocols for subsequent prospective studies.

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