Background: Acute pancreatitis is an inflammatory disease of pancreas that is associated with little or no fibrosis of the gland. Biliary tract disease account for 30-60% cases. Approximately 85% of patients with symptomatic gallstone mainly report biliary colicky pain whereas other patients may present with complications such as acute cholecystitis, acute pancreatitis, cholangitis etc. However, factors predisposing to pancreatitis over other complications of gall stones are not well known. We aim to identify potential factors which can predict the occurrence of pancreatitis in gall stone patients.
Material and Method: A single centre prospective Case Control study. 75 patients each of biliary pancreatitis (Group A) and of acute cholecystitis (group B) were enrolled in study. 6 weeks after acute attack they were assessed for gall bladder motility and taken up for cholecystectomy.
Results: Gallbladder motility was stronger in pancreatitis patients than in patients with acute cholecystitis (residual volume 12.85±1.18 vs 18.13±1.5, p = 0.000 and Ejection Fraction 57.5%%±2.17 vs 44.5%%±3.3, p = 0.000)). Pancreatitis patients more often had sludge (52% vs. 28%; p = 0.0027) and smaller (4.07±0.9mm vs 9.77± 1mm, p = 0.0000.) and more gallstones (32±8 vs 13±6, p = 0.008). Mean Pancreatitis Screening Index(PSI) [Ejection Fraction/ Size of Smallest Calculi] score for Group A was 0.24±0.1 whereas mean score for Group B was 0.063±0.01 (p value is 0.000). At PSI value â¥ 0.132, patients of AP were reliably distinguished from patients with acute cholecystitis (sensitivity=80%, specificity=94.5%).
Conclusion: Acute pancreatitis is more common in patients with smaller multiple stones with preserved gallbladder motility. Pancreatitis Screening Index can be a novel index to identify patients of gall stones at risk of acute pancreatitis. However, the potential beneï¬t and usefulness of the index is yet to be elucidated.
Acute Pancreatitis; Acute Cholecystitis; Ellipsoid method; Ejection Fraction; Pancreatitis Screening Index