Prognosis and risk factors of ERCP pancreatitis in elderly

Post Endoscopic Retrograde Cholangiopancreatography (ERCP) pancreatitis is one of the most serious complications of ERCP. Our study aims to investigate the risk, predisposing factors and prognosis of pancreatitis after ERCP in elderly patients. Patients referred to the ERCP unit between April 2008 and 2012 and admitted to the hospital at least 1 day after the ERCP procedure were included to the study. Information including patient’s demographics, diagnosis, imaging findings, biochemical analysis, details of the ERCP procedure and complications were recorded. The severity of post ERCP pancreatitis (PEP) was determined by revised Atlanta Criteria as well as APACHE II and Ranson scores. A total of 2902 ERCP patients were evaluated and 988 were included to the study. Patients were divided into two groups as ≥ 65 years old (494 patients, 259 F, 235 M) and < 65 years old (494 patients, 274 F, 220 M). PEP was diagnosed in 4.3% of patients aged 65 years and older. The female gender was risk factors in elderly for PEP. The Sphincter Oddi Dysfunction (SOD) and Juxta papillary diverticula (JPD) were higher in elderly patients with PEP. Age did not increase the risk of PEP development. The most important post ERCP pancreatitis risk factor in the elderly is the female gender, while the risk is enhanced slightly by SOD and JPD.

State of Hepatopancreatobiliary system and post-cholecystectomy quality of life

Objective: to assess the quality of life of patients and the state of the hepatopancreatobiliary system before and after cholecystectomy in the long-term period. Materials and methods: at the first stage, 107 people were examined after emergency, planned cholecystectomy (with symptomatic and asymptomatic course of GI). At the second stage, 90 people at different times after cholecystectomy for a more detailed examination of the external secretory function of the pancreas was performed. Results: the majority of patients, regardless of the type of surgery, had symptoms of dyspepsia associated with the development of functional disorders of the gastrointestinal tract (gastroesophageal reflux, duodenogastric reflux, sphincter Oddi dysfunction). A decrease in the external secretory function of the pancreas was shown regardless of the period after cholecystectomy. Conclusion: after cholecystectomy, functional disorders of the digestive system predominate in the long-term period due to loss of the physiological function of the gallbladder.

Controversial issues of gallbladder and sphincter Oddi disorders: analysis of Rome IV criteria (2016).

Functional disorders of biliary tract published in 2016 include functional gallbladder disorders, biliary sphincter Oddi and pancreatic sphincter Oddi disorders. One of the advantages of these criteria is recognition of the diagnosis of such functional disorders as the diagnosis of exclusion, the establishment of which requires the conduction of complex laboratory and instrumental investigations to detect the possible organic diseases. The disadvantages of these new criteria include the lack of development of noninvasive instrumental methods (especially ultrasound method), complexity, inaccessibility and insecurity of recommended diagnostic methods (particularly sphincter Oddi manometry), insufficient attention to the current opportunities of medical therapy.