Endoskopsko liječenje komplikacija akutnog pankreatitisa

master's thesis

• Title (english): Endoscopic management of complications in acute pancreatitis
• Author: Mihovil Penavić
• Mentor: Tajana Pavić (mentor)
• Committee member: Davor Hrabar (predsjednik povjerenstva)
• Committee member: Ivana Vuković Brinar (član povjerenstva)
• Committee member: Tajana Pavić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; Zagreb
• Defense date and country: 2024-07-12, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

U lokalne komplikacije akutnog pankreatitisa ubrajaju se akutna peripankreatična tekuća kolekcija, pseudocista gušterače, akutna nekrotična kolekcija i kasna ozidana nekroza (WON). Pseudocista i kasna ozidana nekroza kronične su komplikacije i, ako su simptomatske, zahtijevaju intervenciju. Endoskopska transluminalna drenaža uključuje formiranje kanala između gastrointestinalnog sustava i lumena kolekcije endoskopskim putem te postavljanje potpornice (stenta). Metalni samoekspandirajući stentovi (engl. LAMS – lumen apposing metal stents) postaju sve rašireniji u kliničkoj praksi i u velikoj mjeri zamjenjuju plastične stentove. Endoskopska transluminalna nekrozektomija sljedeći je korak u endoskopskoj intervenciji ukoliko drenaža nije dostatna za rezoluciju kolekcije.
U ovoj retrospektivnoj studiji usporedili smo ishode liječenja pacijenata s kroničnim peripankreatičnim kolekcijama liječenih endoskopski ugradnjom LAMS-a na Zavodu za gastroenterologiju i hepatologiju Klinike za unutarnje bolesti KBC-a Sestre milosrdnice u periodu od studenoga 2016. do studenoga 2023. godine. U tom periodu liječena su 52 bolesnika, od čega 62% muških i 38% ženskih. Prosječna dob ispitanika bila je 57,7 ± 11,9 godina. U 49 (94%) slučajeva bilo je riječ o WON-ovima, dok su preostali bili pankreatične pseudociste (6%). Etiologija pankreatitisa većinski je bila bilijarna (87%). Tehnički uspjeh procedure bio je 100%, uz klinički uspjeh od 96%. Od 52 ispitanika uključena u analizu, samo je 6% imalo značajne komplikacije zahvata, uz dva smrtna slučaja. Bolesnici su imali značajan pad tjelesne mase, ali bez pada skeletne mišićne mase. Sarkopeniju je imalo 27% bolesnika i prije i nakon endoskopskog liječenja što je pokazalo da sarkopenija uistinu nastaje u ovoj bolesti, ali i da se može spriječiti njeno pogoršanje ili uopće razvoj adekvatnim liječenjem i nutritivnom intervencijom, posebice visokim dnevnim unosom proteina.

Abstract (english)

Local complications of acute pancreatitis include acute peripancreatic liquid collection, pancreatic pseudocyst, acute necrotic collection, and walled-off necrosis (WON). Pseudocyst and walled-off necrosis are considered chronic complications and are treated invasively in case of being symptomatic. Endoscopic transluminal drainage involves the formation of a channel between the gastrointestinal system and the lumen of the collection and placement of a stent. Lumen-apposing metal stents (LAMS) are becoming more widespread in practice and are widely replacing plastic stents. Endoscopic transluminal necrosectomy is the next step in endoscopic intervention if drainage is not sufficient to resolve the collection.
In this study, we compared the treatment outcomes of patients with chronic peripancreatic collections treated endoscopically by implantation of LAMS at the Department of Gastroenterology and Hepatology, Department for Internal Diseases, University Hospital Center “Sestre Milosrdnice” in the period from November 2016 to November 2023. 52 patients were treated in that period, of which 62% were male and 38% were female. The average age of the subjects was 57.7 ± 11.9 years. In 49 (94%) cases, the collections were WONs, while the remaining were pancreatic pseudocysts (6%). The etiology of pancreatitis was mostly biliary (87%). The technical success of the procedure was 100% and the clinical success was 96%. Of the 52 patients included in the analysis, significant complications of the procedure were observed in only 6% of the patients along with two cases of death. Patients suffered from a significant decrease in body mass during treatment, but no decrease in skeletal muscle mass was observed. 27% of patients had sarcopenia both before and after the endoscopic treatment, which showed that sarcopenia indeed occurs in this condition, but also that it can be prevented from worsening or even developing by adequate treatment and nutritional intervention, especially by high protein intake.

• Keywords: akutni pankreatitis; gastrointestinalna endoskopija; komplikacije; sarkopenija
• Keywords (english): acute pancreatitis; complications; gastrointestinal endoscopy; sarcopenia
• Language: croatian
• URN:NBN: urn:nbn:hr:105:514479
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2024-07-02 12:35:47