Endoscopic intraduodenal correction of secretory drainage disturbance of the pancreas in the treatment of patients with pancreonecrosis

Objective. The aim of the study is to analyze the results and justify the use of endoscopic intraduodenal correction technologies for secretory drainage disturbances of the pancreas in patients with severe acute pancreatitis. Material and methods. The study is a two-center, retrospective study conducted at Nefteyugansk District Clinical Hospital named after V.I. Yatskiv and Surgut District Clinical Hospital. From 2005 to 2021, endoscopic intraduodenal correction technologies for secretory drainage disturbances of the pancreas was performed in 47 patients with severe acute pancreatitis due to inadequate effectiveness of traditional treatment methods. For restoring pancreatic secretory drainage, endoscopic papillosphincterotomy and wirsungotomy without stenting of the Wirsung duct were performed in 23 patients; in another 24 patients, endoscopic papillosphincterotomy, wirsungotomy, and stenting of the Wirsung duct with pancreatic stents of 5—7 Fr in diameter and lengths from 30 to 155 mm were conducted. The control group consisted of 52 patients comparable in main parameters who did not undergo endoscopic intraduodenal correction technologies for secretory drainage disturbances of the pancreas. The decision regarding the method and extent of endoscopic intraduodenal correction technologies for secretory drainage disturbances of the pancreas was primarily based on data from objective research methods — multislice computed tomography with bolus contrast enhancement. Results. In the main group of patients who underwent endoscopic intraduodenal correction technologies for secretory drainage disturbances of the pancreas, in comparison with the control group, the frequency of invasive interventions for correcting complications of acute pancreatitis decreased from 59.6% to 40.4%, the duration of inpatient treatment was reduced by 20.7%, and mortality decreased from 17.3% to 8.5%. Conclusion. The presence of verified pancreatic necrosis foci compressing the Wirsung duct on multislice computed tomography with bolus contrast enhancement is an indication for the application of endoscopic intraduodenal correction technologies for secretory drainage disturbances of the pancreas methods, as without correction, the disturbance of pancreatic secretion drainage leads to the progression of pancreonecrosis with the spread of inflammatory-necrotic processes to the retroperitoneal tissue, abdominal cavity, and the development of systemic and generalized reactions. The application of endoscopic intraduodenal correction technologies for secretory drainage disturbances of the pancreas techniques in patients with severe acute pancreatitis is surgically safe and leads to a significant improvement in short-term treatment outcomes.