Clinicopathological Study of the Biliary and Duodenal Complications in Patients of Chronic Pancreatitis - A Prospective Observational Study in a Tertiary Care Centre in Eastern India

Abstract

BACKGROUND Chronic pancreatitis is a chronic inflammatory disease, causing complications related to the duodenum like duodenal obstruction or complications related to the biliary system like cholestasis, cholangitis, secondary biliary cirrhosis and cholangiocarcinoma. The purpose of the study was to observe the occurrence, clinical manifestations and outcome of the complications and foster a deeper understanding of the long-term prognosis of patients suffering from chronic pancreatitis. METHODS This was a prospective observational study. After taking informed consent, total 50 patients admitted in hospital with features suggestive of chronic pancreatitis with or without duodenal or biliary complications were selected and were followed up throughout the course of the disease. All demographic parameters, diabetic status, liver function test, USG findings suggestive of duodenal obstruction or biliary abnormalities, upper GI endoscopy, computed tomography of whole abdomen, MR cholangio pancreatography and barium meal were studied. RESULTS Chronic pancreatitis is more common in male and the common age of presentation is between 45 and 54 years. 12 patients were diabetics. 42 % of the total 50 patients developed transient hyperbilirubinaemia. 5 male patients and 1 female patient had persistent hyperbilirubinaemia and had persistently raised values of alkaline phosphatase. 1 male and 2 female patients also suffered from hypoproteinaemia. About 42 % of the patients of chronic pancreatitis suffered from transient rise in conjugated bilirubin and were managed conservatively. 12 % of the patients suffered from persistently raised conjugated bilirubin, indicating biliary obstruction. 22 % of patients developed cholangitis responding to conservative management. 12 % of cases, 5 males and 1 female suffered from biliary stricture, and were managed surgically with hepaticojejunostomy. No cases of cholangiocarcinoma were detected. CONCLUSIONS The most common complication in patients of chronic pancreatitis is transient biliary stasis, others being cholangitis and persistent hyperbilirubinaemia. No cases of cholangiocarcinoma were detected. KEYWORDS Billiary, Duodenal, Complications, Stricture, Cholestasis, Cholangitis, Chronic, Pancreatitis