ObjectiveTo summarize new progress in diagnosis and treatment of acute biliary pancreatitis at present.MethodThe related literatures on the acute biliary pancreatitis in recent years were searched and reviewed.ResultsThe acute biliary pancreatitis was a common acute abdomen in the surgery. The biliary stone was the main cause of the disease. The disease was acute, rapid, and has a high mortality rate. It was not difficult to make a diagnosis by relying on the imaging and laboratory tests. The active non-surgical treatment and surgical intervention were the key to a clear diagnosis, but the appropriate surgical timing should be chosen.ConclusionsFor acute biliary pancreatitis, active surgical intervention based on non-surgical treatment is focus of treatment. Reasonable choice of surgical methods and timely surgical intervention can effectively prevent progression of disease, reduce mortality rate, and maximize patients’ benefits.
ObjectiveTo investigate the independent risk factors for acute biliary pancreatitis (ABP) induced by gallstones, and to develop a nomogram prediction model for the onset of ABP, thereby enabling early identification of high-risk patients and the formulation of individualized management plans, so as to provide a scientific basis for improving the clinical management of ABP. MethodsThe patients with gallstones who were admitted to the Department of Hepatobiliary and Pancreatic Surgery, Suining Central Hospital from January 2022 to January 2024 were collected. The patients were randomly divided into a training set and a validation set in a 7∶3 ratio. Univariate and multivariate logistic regression analyses were applied to identify independent risk factors for ABP and to develop a nomogram prediction model. The discriminative ability, calibration, and clinical utility of the prediction model were evaluated using the receiver operating characteristic (ROC) curve, calibration curve, Hosmer-Lemeshow test, and decision curve analysis. The accuracy and stability of the prediction model were further tested using the validation set. ResultsA total of 1 103 patients with gallstones were included, comprising 772 in the training set and 331 in the validation set. Among them, 137 (17.75%) and 60 (18.13%) patients in the training and validation sets, respectively, were complicated with ABP. Multivariate logistic regression analysis in the training set revealed that age [OR (95%CI)=1.03 (1.01, 1.04), P=0.002], normal gallbladder size [OR (95%CI)=5.36 (2.70, 10.65), P<0.001], gallstone diameter ≤1 cm [OR (95%CI)=6.26 (3.23, 12.14), P<0.001], round-shaped gallstones [OR (95%CI)=11.29 (5.42, 23.51), P<0.001], multiple gallstones [OR (95%CI)=1.37 (1.17, 1.81), P=0.013], and common bile duct diameter ≥1 cm [OR (95%CI)=4.44 (1.37, 14.41), P=0.013] were independent risk factors for ABP induced by gallstones. Based on these risk factors, a nomogram prediction model was constructed. The model demonstrated area under the ROC curve for distinguishing patients with ABP induced by gallstones were 0.873 [95%CI (0.842, 0.905)] in the training set and 0.858 [95%CI (0.810, 0.905)] in the validation set, respectively. The calibration of the model by the Hosmer-Lemeshow test indicated a good fit between predicted and actual probabilities (training set: χ2=14.061, P=0.080; validation set: χ2=7.656, P=0.468). Internal validation via the Bootstrap method (1 000 resamples) yielded calibration curves for both the training and validation sets that closely aligned with the ideal diagonal line. In both the training and validation sets, the patients with gallstone would benefit from intervention according to the nomogram at threshold probabilities of 0.03–0.88 and 0.89–0.91, respectively. ConclusionsThis study confirms that age, normal gallbladder size, gallstone characteristics (diameter ≤1 cm, round shape, and multiple stones), and common bile duct dilation (diameter ≥1 cm) are independent risk factors for ABP induced by gallstones. The nomogram prediction model constructed based on these factors demonstrates good discrimination and calibration in both the training and validation sets, and decision curve analysis confirmes its ideal clinical utility. This model provides clinicians with an intuitive and reliable quantitative tool for early identification of high-risk ABP patients and the development of individualized prevention and management strategies.
ObjectiveTo understand advances in the timing and surgical mode selection of gastrointestinal endoscopy and surgical intervention for acute biliary pancreatitis (ABP).MethodThe recent literatures on the timing and choice of gastrointestinal endoscopy and surgical treatments aimed at ABP were reviewed.ResultsFor ABP patients with early cholangitis or biliary obstruction, no matter how serious, endoscopic treatment should be used to relieve obstruction and relieve symptoms. For patients only with ABP, if non-surgical treatment was not effective and patients showed symptoms such as biliary obstruction or biliary tract infection, endoscopic intervention should be considered. Most ABP patients had milder symptoms and could undergo cholecystectomy during the same hospitalization to prevent ABP recurrence after symptoms relief. Patients with severe ABP could be treated with cholecystectomy along with pancreatic necrotic tissue removal, and surgery should be performed after the disease was controlled. If the preoperative imaging examination highly suspected that there were stones in the biliary tract, biliary exploration should be performed at the same time. Laparoscopic surgery should be selected as far as possible to facilitate the postoperative recovery of the patient.ConclusionsFor patients with ABP, whether endoscopic or surgical treatment, the timing and surgical mode selection should follow the specific clinical situation with the “individualization” principle of the treatment. We should make the reasonable and effective policy at diagnosis and treatment according to different conditions.
