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Diagnostisches und therapeutisches Vorgehen bei biliärer Pankreatitis

Diagnostic and therapeutic proceeding in acute biliary pancreatitis

  • Themenschwerpunkt: Akute Pankreatitis
  • Published:
Acta Chirurgica Austriaca Aims and scope Submit manuscript

Zusammenfassung

Grundlagen

Etwa 35 bis 50% der Fälle von akuter Pankreatitis werden durch Gallensteine ausgelöst, auch ein erheblicher Teil der bis jetzt als idiopathisch eingestuften Fälle scheinen durch Gallen-Sludge oder Mikrosteine induziert zu werden. Die prognose und die allgemeine Therapierichtlinie unterscheidet sich nicht von anderen Formen der akuten Pankreatitis. Trotzdem ist die rechtzeitige Erkennung der biliären Genese von erheblicher Bedeutung da sich daraus kausale Therapieoptionen ergeben können.

Methodik

Der Wert der Diagnostik und Therapie wird in einer Übersich dargestellt.

Ergebnisse

In der Regel kann die biliäre Genese der akuten Pankreatitis in 90 bis 95% der Fälle an Hand anamnestischer Hinweise, der typischen Laborkonstellation und dem sonographischen Befund richtig eingeschätzt werden. Die Indikation zur ERCP und eventueller EPT bei diagnostizierter akuter biliärer Pankreatitis ist nicht eindeutig geklärt. Studien konnten eine geringere Komplikationsrate bzw, eine geringere Cholangitisrate bei frühzeitiger ERCP mit EPT zeigen.

Schlußfolgerungen

Gesichert ist der Einsatz der ERCP jedoch nur bei Verdacht auf Steininkarzeration, ausgeprägter Cholestase oder Ranson-Kriterien >4 bei Aufnahme. Eine elektive Cholezystektomie sollte bei gesicherter biliärer Genese und nachgewiesenen Gallenblasensteinen zeitlich verzögert noch während dem selben stationären Aufenthalt erfolgen.

Summary

Background

Gallstones are the most common cause of acute pancreatitis, accounting for approximately 35 to 50% of cases. In addition, microlithiasis is considered to be the presumed cause of most cases of the so-called idiopathic acute pancreatitis. In relation to prognosis and guidelines of supportive treatment there is no distinction between the different etiologic factors of acute pancreatitis. Nevertheless early identification of an obstructive cause of acute pancreatitis is quite important, because this might result in a specific therapeutic approach.

Methods

The value of diagnosis and treatment are reviewed.

Results

As a rule, 90 to 95% of the gallstone associated causes of acute pancreatitis are correctly diagnosed by the typical clinical manifestations, the laboratory test abnormalities and the sonographic findings. The early enforcement of the Endoscopic Retrograde Cholangiopancreaticography (ERCP) with Endoscopic Spincterotomy (ES) in acute biliary pancreatitis is still a controversial discussion. Some reports suggest that an early ERCP with ES can reduce the rate of complications.

Conclusions

Until now only the ampullary stone impaction, a distinct cholestasis or Ranson’s criteria >4 are proven causes for an immediate endoscopic removal of gallstones. A delayed cholecystectomy should be performed if stones in the gallbladder are detectable.

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Authors and Affiliations

  1. Medizinische Klinik. Friedrich-Wilhelm Universität, Sigmund-Freud Straße 25, D-53105, Bonn, Deutschland

    Ch Lamberti

  2. Zentrum für Innere Medizin der Klinik für Gastroenterologie, Hepatologie und Infektiologie der Universität Magdeburg, Deutschland

    P. Malfertheiner

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  2. P. Malfertheiner
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Lamberti, C., Malfertheiner, P. Diagnostisches und therapeutisches Vorgehen bei biliärer Pankreatitis. Acta Chir Austriaca 27, 198–201 (1995). https://doi.org/10.1007/BF02616522

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  • DOI: https://doi.org/10.1007/BF02616522

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