Biliary pancreatitis (Part 2)

The mortality rate is virtually zero if there is no organ failure, but increases to nearly 20% if at least one of the above criteria is met. Patients with organ failure are more likely to have necrotizing than interstitial pancreatitis. However, waiting for such complications to occur may negate the benefits of early therapy.

Early prognostic indices have been employed during the patient’s initial evaluation. These include the biliary version of Ranson’s criteria that are frequently used in the United States, the modified Imrie’s criteria that are used mainly in Europe, and APACHE-II scores that are widely used in intensive care units.

They reflect the effects of pancreatic injury and, if present, of concurrent biliary obstruction with or without cholangitis, on fluid and metabolic status and extra-pancreatic organs. Their sensitivities and specificities in predicting mortality are 90% and 80%, respectively.

CT with dynamic contrast enhancement has provided additional useful prognostic information. The use of intravenous contrast material permits the delineation of nonperfused tissue in and around the pancreas. Ischemia is a consequence of damage to the microcirculation. A grading system has been developed that reflects the amount of retroperitoneal (including pancreatic) necrosis: higher CT grades are associated with worse prognosis.

In addition to aiding clinical management, the use of prognostic indices facilitates the comparison of therapeutic studies undertaken in different institutions.

The first RCT of endoscopic retrograde cholangiopancreatography (ERCP) and ES was conducted by the Leicester group from 1983 to 1987, after sporadic reports of rapid improvement of clinical and laboratory parameters with these techniques. The benefits of early endoscopic therapy were substantiated, and concerns about exacerbation of pancreatitis, cholangitis, hemorrhage and perforation were not realized. Since then, three more RCTs of this therapy have been conducted. Discover tons of opportunities to shop with best pharmacy on the internet and get cialis super active online click here paying a lot less money every time you shop for the drugs you need.

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