DIAGNOSTIC FEATURES OF PSEUDOCYST WALL FORMATION AND INFLAMMATORY ACTIVITY IN CHRONIC PANCREATITIS
Summary. Objective. To increase the efficiency of diagnostics in determining the wall formation of the pancreatic pseudocyst and the activity of the inflammatory process.
Materials and methods. A total of 99 patients were examined who underwent digestive tract surgery from 2006 to 2019 with pseudocyst that developed on the background of acute and chronic pancreatitis.
There were 73 males (73.74 %), 26 females (26.26 %), 21 to 74 years of age (47.55–2.4 years). Based on the morphological data of the biopsy material, pancreatic pseudocyst (PC) wall formation and inflammatory activity in chronic pancreatitis, patients were divided into two representative groups: Group I (n = 41) — patients with formed wall of PC, group II (n=58) — patients with unformed PC wall. Morphology data were compared with the data of immunological parameters and radiation diagnostic methods.
Results. The TNF-α/IL-10 ratio was higher (p <0.05) in patients in group II than in group I. To differentiate the activity of inflammation, a threshold value of 1.4 was set (sensitivity — 86.7 %, specificity — 59.1 %). The IL-6/IL-10 ratio was higher (p <0.05) in group II patients, which also indicated an imbalance of pro- and anti-inflammatory mediators and was characteristic of active inflammation. The threshold value of the ratio of IL-6/IL-10, above which patients were diagnosed with active inflammation in the PC wall — less than or equal to 1.1 (sensitivity — 91.7 %, specificity — 84.6 %). In group II patients, the level of PMN-elastase was higher (p<0.05) than in group I, which indicated the activity of inflammation. Threshold of fecal PMN-elastase, above which patients were diagnosed with active inflammation of PC wall less than or equal to 84 ng/ml (sensitivity — 90.9 %, specificity - 66.7 %). 3. According to ultrasound/MSCT, the wall thickness of PC in group I was (4.41±0.49)/(4.27±2.02) mm, in group II (2.50±0.52)/(2.75±1.44) mm, which is probably less than 1.7 times and 1.6 times (p <0.05) with the unformed PC wall. According to SWE, the threshold value of the average stiffness values of the PC wall, above which it was diagnosed, was> 7.6 kPa (sensitivity — 80.0 %, specificity 78.9 %).
Conclusions. Indices of TNF-α/IL-10, IL-6/IL-10, PMN-elastase, ultrasound, MSCT, SWE have been determined, which allow to evaluate the formation of PC wall and the activity of the inflammatory process.
2. Advanced imaging techniques for chronic pancreatitis / Parakh A, Tirkes T. Abdom Radiol (NY). 2019 Aug 19. doi: 10.1007/s00261-019-02191-0. [Epub ahead of print] Review.
3. Acute Pancreatitis and Fluid-Filled Collections: Etiology and Endoscopic Management / Lancaster A, Zwijacz M.// Gastroenterol Nurs. 2019 Sep/Oct;42(5):417-419. doi: 10.1097/SGA.0000000000000396.
4. Etiologic Distribution of Pancreatic Cystic Lesions Identified on Computed Tomography/Magnetic Resonance Imaging./Munigala S, Javia SB, Agarwal B.//Pancreas. 2019 Sep;48(8):1092-1097. doi: 10.1097/MPA.0000000000001372.
5. Identification of risk factors for pancreatic pseudocysts formation, intervention and recurrence: a 15-year retrospective analysis in a tertiary hospital in China. / Tan JH, Zhou L, Cao RC, Zhang GW. // BMC Gastroenterol. 2018 Oct 1;18(1):143. doi: 10.1186/s12876-018-0874-z. PMID: 30285639.
6. Management of pancreatic pseudocysts — A retrospective analysis / S. Rasch, B. N?tzel, V. Phillip, T. Lahmer, R. M. Schmid, H. Alg?l // DOI: 10.1371/journal.pone.0184374, September, 2017.
7. Methods of treatment of postnecroctic pancreatic cysts: modern looks of the problem(literaturereview) / NoskovI.G. Acta Biomedica Scientifica. 2017. Т. 2. № 5-1 (117). С. 147-154. DOI: 10.12737/article_59e85bb96921e5.67783675.
8. Surgical treatment of pancreatic pseudocysts / Martínez-Ordaz JL, Toledo-Toral C, Franco-Guerrero N, Tun-Abraham M, Souza-Gallardo LM.Cir Cir. 2016 Jul-Aug;84(4):288-92. doi: 10.1016/j.circir.2015.09.001.