Take Care of Your Pancreas!

Depending on the phase acute pancreatitis (AP) has a polymorphic sonographic picture. Diagnostic accuracy of non-invasive ultrasonic tomography (UST) in verification of the stage of development of AP and character of its complications usually does not exceed 80 % that makes puncture biopsy necesssary.

The basic method to choose the zone to intake the material and make fine-needle biopsy is to reveal necrosis zones with the help of estimation of the blood flow in the pancreatic area in a regimen of color doppler mapping and make comparative estimation of the amount of doppler signals in the thickness of the pancreas and its surface. A 50 % decrease in number of doppler signals serves as a precise marker of necrosis and the destructive process in the pancreas.

Diagnostic fine-needle puncture biopsy (PB) with microbiological and cytologic examination of the aspirate is necessary with patients suspected of the destructive form of AP. Results of PB allow to use LIM under utrasonic guidance differentially and to choose the proper medical treatment in case of various forms of pancreatitis.

When diagnostic fine-needle puncture is used efficiency of the traditional ultrasonic investigation of various forms acute pancreatitis is increased.

Diagnostic efficiency of ultrasonic tomography (UST) with low-invasive manipulations (LIM) in differential diagnostics of various morphological forms of acute pancreatitis (AP) can be represented in the following table (one of the first examinations). LIM under ultrasonic guidance are specifying diagnostics, therefore, specificity is constant.

A combination of paracentetic treatments (diapeutic LIM) and drainage installation is the basis of the medical LIM in case of complicated acute pancreatitis. Manipulations are carried out in the certain sequence. There is a combination of aspirating needles and drainages of various diameter and type. As a matter of fact, frequency of a puncturation also changes. Medical programs are usually based on the results of organoleptic and analytical examination of the material.

At present the general approaches to diagnostics and treatment of various forms of acute pancreatitis (AP) are determined. They assume a complex conservative therapy of abortive AP and refusal from early open operations in case of sterile pancreatonecrosis.

Usually purulo-septic complications of pancreatonecrosis indicate that surgical treatment is needed, however the question of the proper sanation method (open surgical operation, beam diapeutics, endoscopy) is debatable. Also the question of expediency of surgical sanation of sterile pancreatonecrosis remains. It is because of the variety of clinicopathologic forms of destructive pancreatitis and disagreements in differentiation between “sterile” and “infected” forms of pancreatonecrosis. The fact is that their clinical and laboratory manifestations are often similar, and traditionall methods of instrumental diagnostics not always allow to determine exactly the development of the infection in the affected zones of the pancreas (P) and/or retroperitoneal tissue.

At present taking into account the probabilistic nature of noninvasive ultrasonic tomography (UST) in verification of pancreatonecrosis, the early and reliable detection of its aseptic and septic forms can be possible only in case of microscopic and microbiological investigation of the material taken by diagnostic puncture under ultrasonic guidance.

We have analyzed lots of literature and come to the conclusion that the question of timely diagnosis of pancreatonecrosis and justified use of drainage and other low-invasive surgical methods at different stages of disease development is very urgent.

Exploratory puncture under ultrasonic guidance is of extensive current use in the diagnosis of aseptic and septic pancreatonecrosis types at the early stage.

Our aim is to determine the role of ultrasonic tomography, including puncture biopsy of the pancreas under ultrasonic guidance, in the diagnosis and treatment of acute destructive pancreatitis.

We held one-day puncture biopsy examinations under ultrasonic guidance of 50 hospitalized patients suspected of destructive pancreatitis. The biopsy examination was multifocal: with the signs of the spare fluid the 4 spot intake was made from at least 2 parts of the pancreas and the omental bursa zone with the needle of the Chiba and Angiomed G 22-21 type. In order to intake cellular material from the pancreas zone without contamination by gastric flora, аn original method of step change of intaking multiplicity, duration and rate was applied.

The analysis for infection of the pancreas and parapancreatic structures disclosed negative results with 44 patients. The results of the microbiological investigation of 10 patients were positive. Bacterial flora was presented by conditionally pathogenic gram-negative enterobacteria (E.coli, K.pneumoniae, B.cepacia, P.mirabilis) in 60 per cent of cases. The cases of infection by gram-positive agents (S.epidermidis, S.saprophyticus) covered 40 per cent. Sensitivity of the method used attained 91,7 per cent, specificity – 86,5 per cent, accuracy – 89,4 per cent.

Thus, the microbiological and cytological analysis of the aspirate taken by fine-needle aspiration under ultrasonic guidance allowed to determine the state of the pancreas objectively, to specify the pathologic process and its evolution, to verify the mode of tissue involvement in case of pancreatonecrosis.