Predictive risk model of recurrence of acute diverticulitis after the first episode.

INTRODUCTION: The recurrence of acute diverticulitis (AD) of the colon is frequent and leads to hospital readmissions and the need for elective surgery in selected cases. It is important to individualize risk factors and develop predictive tools for their identification. MATERIALS AND METHODS: This prospective observational study included 368 patients who were diagnosed with AD between 2016 and 2021 in a tertiary general university hospital during their first episode and who had a good response to antibiotic, percutaneous, or peritoneal lavage treatment. Univariate and multivariate Cox regression analyses of the variables associated with recurrence were performed. Subsequently, a predictive risk score was developed and validated through survival studies. RESULTS: After a median follow-up of 50 months, there were 71 (19.3%) cases of recurrence out of a total of 368 patients. The mean time of recurrence was 15 months, and 73.3% of cases of recurrence occurred before 2 years of follow-up. Recurrence was independently associated with presentation with colonic perforation in the antimesenteric location (HR 3.67 95% CI [1.59-8.4]) and a CRP level greater than 100 mg/dl (HR 1.69 95% CI [1.04-2.77). A score with 5 variables was created that differentiated two risk groups: intermediate risk (0-3 points), with 19% recurrence and high risk (more than 3 points), with 42% recurrence. CONCLUSIONS: The risk of recurrence after the first episode of diverticulitis can be estimated using predictive scores. The detection of high-risk patients facilitates the individualization of follow-up and treatment.

Pancreatitis biliar. Cinética de pruebas funcionales hepáticas y canal común biliopancreático - reflujo biliopancreático / Biliary pancreatitis. Liver function tests and common biliopancreatic channel kinetics - biliopancreatic reflux

OBJETIVO: Estudio de la prevalencia de reflujo biliopancreático (RBP)/canal común biliopancreático (CCBP) en pacientes con pancreatitis biliar (PB) sometidos a colecistetomía (CST) y colangiografía intraoperatoria (CIO) y análisis de la cinética de pruebas funcionales hepáticas (PFH) en comparación con un grupo control (GC) de colelitiasis sintomática. MATERIAL Y MÉTODOS: Estudio retrospectivo de 107 pacientes consecutivos con PB. Se determinó la existencia de RBP-CCBP en la CIO y se analizaron las PFH al ingreso (AI), a las 48 horas y en el examen preoperatorio (AP). La variación analítica se analizó entre grupos según existencia de RBP-CCBP y entre el AI y AP, según intervalo ingreso-intervención (III) y dentro del mismo grupo mediante determinación de la ratio valor observado-valor máximo normal (VO/VMN). RESULTADOS: La incidencia de CCBP fue de 38,3% en PB vs 5,0 en GC (p = 0,0001) y fue independiente del III a diferencia de la odditis apuntando a una alteración anatómica para la primera y funcional para la segunda. Las variaciones analíticas no muestran diferencias entre grupos en función de la existencia de CCBP, pero con ausencia de diferencias al analizar la ratio VO/VMN en FA y GGT, lo que indica un mayor grado de colestasis en los pacientes con RBP-CCBP. La incidencia de dilatación de vía biliar US fue del 10,3% asociándose a CCBP. CONCLUSIONES: El RBP-CCBP en PB genera un mayor grado de colestasis e incertidumbre en la estimación de coledocolitiasis asociada y excesiva sobreindicación de ERCP-EE. Los marcadores US y bioquímicos de coledocolitiasis tienen una baja especificidad en PB por la existencia de CCBP lo que obliga a incluir a la colangiografía por RMN como exploración previa a la ERCP-EE

OBJECTIVE: To determine the prevalence of biliopancreatic reflux (BPR) in patients with biliary pancreatitis (BP) undergoing elective cholecystectomy with intraoperative cholangiography (IOC) in comparison with a control group of symptomatic cholelithiasis (CG). PATIENTS AND METHODS: Retrospective review of 107 consecutive BP cases. BPR was determined by IOC and liver function tests (LFT) were recorded at admission (A), 48hours, and preoperative examination (P). LFT analysis between A and P were analysed between groups with respect to BPR, time interval to cholecystectomy within the same group and by determination of observed value/maximum normal value ratio (OV/MNV). RESULTS: BPR incidence was 38.3% in BP in comparison with 5% in CG (p = 0.0001) it was independent from interval time to cholecystectomy, in contrast with Odditis, suggesting an anatomical condition for CCBP and a functional one for Odditis. LFT analysis showed no differences in relation to BPR incidence. LFT excluding AP and GGT returned to normal values with significant differences in OV/MNV when BPR was present which points to an increased cholestasis in BPR group. US dilatation of CBD was noted in 10.3% and was associated to CCBP. CONCLUSIONS: BPR in BP increases cholestasis and contributes to confusion in the estimation of common bile duct stones increasing ERCP-EE rates. US and biochemical markers of CBDS show a low specificity due to BPR-CCBP which suggests that MRI-cholangiography is a mandatory exploration before ERCP-EE examination

Biliary Pancreatitis. Liver Function Tests and Common Biliopancreatic Channel Kinetics--Biliopancreatic Reflux.

OBJECTIVE: To determine the prevalence of biliopancreatic reflux (BPR) in patients with biliary pancreatitis (BP) undergoing elective cholecystectomy with intraoperative cholangiography (IOC) in comparison with a control group of symptomatic cholelithiasis (CG). PATIENTS AND METHODS: Retrospective review of 107 consecutive BP cases. BPR was determined by IOC and liver function tests (LFT) were recorded at admission (A), 48hours, and preoperative examination (P). LFT analysis between A and P were analysed between groups with respect to BPR, time interval to cholecystectomy within the same group and by determination of observed value/maximum normal value ratio (OV/MNV). RESULTS: BPR incidence was 38.3% in BP in comparison with 5% in CG (p=0.0001) it was independent from interval time to cholecystectomy, in contrast with Odditis, suggesting an anatomical condition for CCBP and a functional one for Odditis. LFT analysis showed no differences in relation to BPR incidence. LFT excluding AP and GGT returned to normal values with significant differences in OV/MNV when BPR was present which points to an increased cholestasis in BPR group. US dilatation of CBD was noted in 10.3% and was associated to CCBP. CONCLUSIONS: BPR in BP increases cholestasis and contributes to confusion in the estimation of common bile duct stones increasing ERCP-EE rates. US and biochemical markers of CBDS show a low specificity due to BPR-CCBP which suggests that MRI-cholangiography is a mandatory exploration before ERCP-EE examination.