The Clinical Value Of Early Endoscopic Treatment In Severe Acute Biliary Pancreatitis

Objective:To evaluate whether there is difference in efficacy between early non-surgical treatment and early endoscopic treatment in severe acute biliary pancreatitis (SABP).Methods:This prospective randomized study was performed from September2010to November2012.54cases were randomly divided into early non-surgical treatment group (ENT) or early endoscopic treatment group (EET, endoscopic therapy performed within72hours). Outcome measures included changes in APACHE-Ⅱ, SOFA and Balthazar CT scores during the first week after admission, incidence of local complications, and overall morbidity and mortality.Results:1. The clinical data of ENT group and EET group, including the sex ratio (P=0.76), age (P=0.43), time of onset (P=0.80), the admission serum total bilirubin (P=0.92), glucose (P=0.38), are no significant differences and highly comparable.2. There was no significant difference of the mean APACHE-Ⅱ scores between the EET group and ENT group at the time of admission and1,2,3,7days later (P=0.14,0.13,0.20,0.18,0.43). The mean APACHE-Ⅱ scores of ENT group in the five time points above were12.13±3.27,7.90±4.28,6.07±3.77,5.10±3.37and4.47±3.63respectively. And the corresponding scores of EET group were12.25±3.39,6.08±4.24,4.75±3.21,3.92±2.32and3.75±2.45.3. There was no significant difference of the mean SOFA scores between the ENT group and EET group at the time of admission and1,2,3,7days later (P=0.82,0.56,0.75,0.77,0.55). The mean SOFA scores of ENT group in the five time points above were1.37±1.16,1.07±1.11,0.93±1.14,0.77±1.07and0.73±1.05. And the corresponding scores of EET group were1.42±1.06,1.25±1.11,0.83±1.01,0.71±1.00and0.58±1.06.4. There was no significant difference of the mean Balthazar CT scores between the ENT group and EET group at the time of admission and7days later. The mean Balthazar CT scores of ENT group in the two time points above were2.67±1.27and 2.63±1.35. The mean Balthazar CT scores of EET group in the two time points above were2.25±1.07and2.25±1.11. The mean scores of ENT group decreased by0.03±0.81, and the EET group was reduced0.08±0.72. There was no significant difference between the two groups (the probability of ENT group was0.27; the probability of EET group was0.21).5. The total organ failure rates of ENT group (43.3%) and the EET group (37.5%) were no significantly different (P=0.67). The total local complication rates of the two groups were20.0%and25.0%, compared to no significant difference (P=0.87).Conclusion:Compared with early nonsurgical treatment, early endoscopic treatment did not significantly reduce the systemic and local morbidity and overall mortality in severe acute biliary pancreatitis.