No abstract

Background/Aim: The Fistula Risk Score (FRS), as other risk scores, is a validated model predicting the development of a clinically relevant post-operative pancreatic fistula (CR-POPF) after pancreaticoduodenectomy (PD). We evaluated risk factors related with CR-POPF and correlated four predictive scores with the likelihood of developing CR-POPF in our cohort. Patients and Methods: The records of 107 patients who underwent PD from 2007 to 2015 were obtained from a prospectively maintained database and reviewed. CR-POPFs were categorized by the International Study Group of Pancreatic Fistula (ISGPF) standards. Firstly, a univariate and multivariate analysis of risk factors related to CR-PPOPF was performed, and then the data were correlated with FRS, Wellner's, Robert's and Yamamoto's scores. Results: In total, 30 patients developed a CR-POPF. On multivariate analysis, abdominal thickness (OR=1.02, p=0.010), Wirsung's duct diameter (OR=0.57, p=0.029), pancreatic consistency (OR=3.18, p=0.011) and histological diagnosis of the lesion (OR=1.65, p=0.012) represented independent predictive factors of CR-POPF. FRS (R 2 =0.596, p=0.001), Wellner's score (R 2 =0.285, p=0.005) and Roberts' score (R 2 =0.385, p=0.002) correlated with the likelihood of developing CR-POPF. Conclusion: Abdominal thickness, Wirsung's duct diameter, pancreatic consistency and histological diagnosis were independent predictive factors of CR-POPF. Predictive scores reflected the likelihood of CR-POPF, FRS being the score with the highest predictive value.

(n=13). Results: The applied risk score kept its fistula predictive value for patients with modified Blumgart anastomosis (p<0,001). There were significantly less clinically relevant fistulas (7,7% vs 47,7%, p<0,001) in Group 3 compared to Group 2, and these were less severe according to the Clavien-Dindo complication scale. Among the intermediate/high-risk patients, Group 3 had shorter median postoperative length of stay (14 vs 19 days) and lower clinically relevant complication rate than Group 2 (15,4% vs 47,4%). Conclusion: Selective external pancreatic drainage in intermediate/high-risk patients associated to a modified Blumgart anastomosis mitigates the fistula risk after duodenopancreatectomy. Fistula risk scores should be used for decision-making purposes in the perioperative period.

Background: Abnormal liver enzyme tests (LET) are frequent in acute biliary pancreatitis (ABP), and not always related to persistent common bile duct stones (CBDS). The aim of our study was to determine whether LET on admission, value variations at 24 h and dilated common bile duct (CBD) on ultrasound (US) are appropriate predictors of CBDS in mild ABP. Methods: Data were analysed from our prospective database of 56 consecutive patients diagnosed of mild ABP; of whom 14(25%) had persistent CBDS confirmed by endoscopic retrograde cholangio-pancreatography. LET; alanin aminotransferase (ALT), aspartate aminotransferase (AST) and total bilirubin (TB) on admission and at 24 h were evaluated. Higher LET values were considered: TB>1.2mg/dl, AST>75U/l, ALT>75U/l. Abdominal US was performed. Predictive accuracy of the variables was measured using area-under-the-receiver-operating characteristic curve (AUC) analysis. Results: Neither abnormal LET on admission or its raised values at 24h showed accuracy in predicting CBDS (AUC values under 0.5), nor did the association of the 3 abnormal LET (AUC=0.66; 0.51-0.82). However, dilated CBD on US showed good accuracy for predicting CBDS (AUC=0.75; 0.58-0.91). Conclusion:A dilated CBD on US seems to be superior than abnormal LET in predicting CBDS in mild ABP, it could help to guide decisions making in the emergency setting of mild ABP, on selection of patients who will benefit from other specific imaging techniques.