Troubles pancréatiques et thérapie
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Abstrait

La tomodensitométrie précoce est-elle utile dans la prise de décision quotidienne en cas de pancréatite aiguë ? Analyse de 248 patients consécutifs dans un hôpital italien de soins tertiaires

Gianpaolo Marte*, Bruno Pauletti, Tommaso Stecca, Cesare Ruffolo, Giorgio Alfredo Spedicato, Giovanni Morana, Marco Massani

Objective: The aim of our study is to verify the prognostic role of Computed Tomography (CT) in early (2 days after symptoms onset) and delayed (>7 days) phase of moderately severe and severe acute pancreatitis (AP) based on revised Atlanta 2012 classification (RAC) in a tertiary care Italian Hospital.

Methods: We retrospectively reviewed 1412 patient’s data, identified via ICD-9 code for AP (577.0), hospitalized from January 2006 to December 2015 in our Surgical Department of Treviso Ca’Foncello Hospital. After exclusion of patients with mild disease, we then analyze 248 patients, all with documented moderately severe and severe AP based on RAC criteria. Early and delayed CT Scan Severity Index (CTSI) in acute pancreatitis were calculated and compared with Bedside Index for Severity in Acute Pancreatitis (BISAP) score and serum C-reactive Protein levels after 48 hours (CRP-48 h).

Results: Concerning all 1412 patients, 17.5% (248 patients) presented moderately severe and severe AP. Of the 248 patients included in our analysis, 133 were male (53.63%) and 115 females (46.37%) with a mean age of 63 years old. Biliary etiology was the most common finding in 47.6% of the cases, followed by alcohol with 25%, unknown origin 15.3%, post endoscopic cholangiopancreatography (ERCP) procedure in 7.3% of the cases and miscellaneous in 4.8%. At least one CT was performed in all patients. Early and delayed CTSI score showed a statistically significant correlation at Spearman Test (p-value<0.05). CRP-48 h strongly correlates with SIRS criteria.

Discussion: Both early and delayed CTSI do not correlate with organ failure and the severity of pancreatitis. Furthermore, repeating CT scan after few days did not add any statistically significant information. BISAP showed a good predictive accuracy for moderately severe and severe AP but no correlation was found with local imaging findings.

Conclusions: Our study demonstrates that in terms of decision making, CTSI does not provide essential information in early phase, both for systemic and local complications. Other scoring systems, such as BISAP, should be used in early phase for a prognostic evaluation. As most recent guidelines suggest, local complications should be treated later rather than sooner, therefore our attitude nowadays is to delay CT scan or consider MRI as late as possible even in moderately severe and severe pancreatitis.