The Etiology And Endoscopic Management Of Acute Recurrent Pancreatitis

PART ONE:The Etiology and Clinical Feature of Acute Recurrent PancreatitisObjective:To explore the etiology and clinical feature of acute recurrent pancreatitis.Methods:Patients with acute pancreatitis were selected in ChangHai Hospital from January 2001 to December 2008. Looked up the illness record:the address,telephone number,age, sex, etiological factors(such as the history of biliary tract disease, alcoholism, family History, drug history, Past history of every system), symptom, the severity of disease, hospital day, complications, recurrence, the laboratories and iconography inspection(CT,MRLI,EUS,ERCP) were collected. After the follow-up (Dec 2009), the patients were divided into two groups-single attacked group and recurrent attacked group. Compared the two groups and explored which were the high risk factors of ARP. According to Ranson score, APACHE-Ⅱscore and CT score, divided the patients into two groups-acute pancreatitis and severe acute pancreatitis. Compared the severity difference between the two groups. Statistical treatment:χ2 test, t test and logistic stepwise regression were used for multivariable analysis,then the factors with P<0.05 were confirmed the high risk with ARP.Results:Of the 804 patients,512 patients had been attacked once (63.68%),320 cases (62.5%) were male,192 cases (37.5%) were female;292 had been recurrent attacked (36.32%),173 cases(59.25%) were male,119 cases(40.75%)were female.The single attacked group with a mean age of 52 (range,5-89); The recurrently attacked group with a mean age of 44.23 (range,4-86), the age difference between the two groups had statistical significance(P＜0.0001), Recurrent group was younger than the single group. Cholelithiasis, alcohol, diet, hypertriglyceridemia and some other causes were considered as the hige risk factors. Logistic stepwise regression were used for multivariable analysis, Cholelithiasis (P<0.0001), and hypertriglyceridemia (P<0.05) were proved to be correlated with ARP. Of the 201 SAP cases,104 cases (20.31%) belonged to single group and 97 (33..22%) belong to recurrent group. The difference between the two groups had statistical significance(P< 0.0001). The recurrent group was more subject to SAP. The pancreatic pseudocyst was found in 46 patients of the single group and 44 patients of the recurrent group. The difference between the two groups had statistical significance(P<0. 05). The incidence rate of pancreatic pseudocyst was higher in recurrent group.Conclusions:The recurrent group were younger than single group. Cholelithiasis and hypertriglyceridemia were high risk factors of ARP. The incidence rate of SAP and pancreatic pseudocyst was higher in recurrent group.PART TWO:The Endoscopic Management and One Year Follow Up of Acute Recurrent PancreatitisObjective:To investigate the effect of endoscopic management of ARP through one year follow up.Methods:The patients of ARP who accepted the endoscopic management were selected in ChangHai Hosptal from January 2001 to December 2008. Look up the illness record:the address,telephone number,age, sex, causes of disease, endoscopic management, endoscopic complications were collected. After the follow up (December of 2009), the therapeutic effect in 12 months were summaried. Evaluated the remission rate and the complications of endoscopic management.Results:139 patients accepted the endoscopic management. Endoscopic retrograde cholangiopancreatography were proceeded 291 times.4 of 139 underwent diagnostic ERCP,3 of 139 were failure.3 patients were loss follow-up (2.27%),3 patients were died because of other diseases (2.27%); 8 patients turned to surgery:pancreas divisum(1), choledochocyst(2), IPMN (5).In the remaining 118 patients,57 were Cholelithiasis,9 patients relapsed, remission rate was 84.21%; 5 were pancreas divisum,2 patients relapsed, remission rate was 60%; 3 were IPMN,2 patients relapsed, remission rate was33.33%;1 was choledochocyst and 2 were pancreatic duct abnormality, all these three patients were relapsed; 2 were adenoma of duodenal papilla and 1 was inflammation stenosis of duodenal papilla after cholecystectomy, nobody relapsed, remission rate was 100%; the total remission rate was78.81%. Of 139 patients,15 were attacked by acute pancreatitis after ERCP(5.15%),13 with mild acute pancreatitis and 2 with midrange acute pancreatitis, no SAP; 1 was attacked by mild hemorrhage after endoscopic sphincterotomy. No other complications happened after endoscopic management.Conclusions:Endoscopic management was an effective and safty method for ARP, especially to the patients who had outflow obstruction.