Diagnostic accuracy of LDH/AST ratio in the detection of necrosis in ABP by taking CT scan as a Gold standard

Aim: To determine the diagnostic accuracy of LDH/AST ratio in the detection of necrosis in acute biliary pancreatitis by taking a CT scan as a gold standard. Methods: This cross-sectional study was conducted from October 2015 to September 2020. Patients of both sexes and ages ranging from 20 to 70 years with acute biliary pancreatitis were included in the study. Diabetic patients, smokers, and patients who had causes of elevated serum transaminases were excluded from the study. LDH/AST ratio was measured on the 5th post-admission day. A contrast-enhanced CT scan was performed on the 7th post-admission day to validate pancreatic necrosis (PNec). The sensitivity, specificity, and diagnostic accuracy of the LDH/AST ratio were then calculated. Results: A total of 270 pts with acute biliary pancreatitis were included in the study. The mean age was found to be 34.57±5.527 years. Ninety-three (34.4%) patients were male while 177(65.6%) patients were female. Total 43 (15.92%) patients were predicted to develop pancreatic necrosis on LDH/AST Ratio and among them, 42 (15.55%) were confirmed to have necrosis. The sensitivity of detecting PNec on basis of the LDH/AST ratio was 97.8%, specificity of LDH/AST ratio was 99.5%, positive predictive value was 97% and diagnostic accuracy of LDH/AST ratio was 98.9%. Conclusion: It was concluded that the LDH/AST Ratio is a strong biochemical marker to detect pancreatic necrosis. Furthermore, age and gender do not have any significant association with pancreatic necrosis. Keywords: CT Scan, pancreatitis, necrosis

Laser papillosphincterotomy in choledocholithiasis and acute biliary pancreatitis

Objective. The radical elimination of extrahepatic biliary tract pathology in choledocholithiasis and acute biliary pancreatitis (ABP) reduces the risk of infection and eliminates the source of endogenous intoxication; so, the search of safe and effective techniques for endoscopic papillosphincterotomy (EPT) is important.Purpose: to assess outcomes of laser-assisted endoscopic papillosphincterotomy.Material and methods. 288 patients with “wedged” (n = 111) and “valve” (n = 177) choledocholithiasis and acute biliary pancreatitis were divided into two groups depending on EPT technique: in the control group, a papillotome with electrocoagulation cord was used (n = 195); in the main group, laser scalpel was used (n = 93).Results. 87 patients with “wedged” choledocholithiasis were treated with EPT and an end electrode on the wedged stone. 16 patients out of them had mild bleeding which was stopped by irrigation with epinephrine solution (1 : 10 000) followed by the targeted coagulation. The average surgical time was 38 ± 16 min. In 24 patients with rigid and edematous medial wall of the duodenum due to acute biliary pancreatitis, the proposed device plus laser technique for papillosphincterotomy were used (patent of the Russian Federation No. 2614891). There was no bleeding, the average surgical time was 24 ± 12 min. In “valve” choledocholithiasis, laparoscopic cholecystectomy (LCE) was performed; calculi from the common bile duct were removed. In 108 patients during LCE, EPT was made via an antegrade catheter. In 69 patients with anatomical and physiological obstacles caused by the major duodenal papilla, we performed LCE and EPT with laser light via an antegrade guide light made of fluoroplastics (patent of the Russian Federation No. 41594). Concrements from the common bile duct were removed with the Dormia basket.Conclusions. Laser light causes less damage, reliably provides hemostasis along the incision line on the anterior wall of the major duodenal papilla; in addition, a wedged calculus in “wedged” choledocholithiasis and a fluoroplastic light guide in “valve” choledocholithiasis reliably protect the posterior wall of the major duodenal papilla from laser light damage. Laser techniques used in EPT make the treatment of choledocholithiasis in patients with ABP having anatomical and physiological problems due to the major duodenal papilla safe and effective.