Comparision of ranson criteria and MRCP to determinate the prognosis of acute pancreatitis

Introduction and Purpose: Acute pancreatitis (AP) is a disease that starts with digestive enzymes become active in any of etiologic factors and pancreatic auto-digestion occurs. AP, which is characterized with non-bacterial inflammation and can be present with pathological findings as edema and necrosis, can lead serious complications and has higher mortality and morbidity rates, is a serious disease.In our study, we aim to investigate MRCP has a role in determining the prognosis of acute pancreatitis by comparing MRCP and Ranson prognostic scoring system which is based on laboratory and clinical data, scientifically accepted and used in practice.Material and Method: Forty two patients who were treated with a prior diagnosis of acute pancreatitis in Karadeniz Technical University Medicine Faculty Farabi Hospital General Surgery Clinic between January 2010 and June 2011, and performed MRCP and biochemical parameters were evaluated prospectively.Parameters including the patients age, gender, amylase and other biochemical values, type of treatment, complications, etiological factors, morbidity, hospital stay, Ranson scores were evaluated.Patients divided into groups as mild acute pancreatitis who have Ranson score 0-3, moderate acute pancreatitis who have Ranson score 4-5, group with a normal main pancreatic duct morphology and group with abnormal morphology of the main pancreatic duct at the end of study.Results: Twenty two female and eighteen male with a total of 42 patients were included in our study. Patients ages were ranging from 19 to 80 years (mean age 62,76 years). Serum amylase values were ranging from 146 to 3086 IU/liters ( mean 1271,07). While 28 of 42 patients (66,7%) were suffering an attack of biliary pancreatitis, 14 of 42 patients (33,3%) were non biliary acute pancreatitis. Five patients have common bile duct stone in addition to gallbladder stone. Patients were evaluated according to Ranson prognostic scoring system. 3 patients (7,1%) were Ranson score 0, 10 patients (23.8%) were Ranson score 1, 15 patients (35,7%) were Ranson score 2, 11 patients (26.2%) were Ranson score 3, 2 patients (4.8%) were Ranson score 4. Only one patient (2.4%) was with a score of Ranson 5. According to grouping by Ranson score, 39 patients were in mild acute pancreatitis group and 3 patients were in moderate acute pancreatitis group. In addition to MRCP, computed tomography scan performed in 21 patients and ultrasound imaging in 31 patients. According to results of MRCP, 4 patients (9.5%) had dilatation of the main pancreatic duct, only 1 patient had stenosis of the main pancreatic duct. 37(88.2%) patients had normal main pancreatic duct. By grouping based on MRCP images only 5 patients were in abnormal main pancreatic duct group. Thirty seven of 42 patients were normal main pancreatic duct group. %10,3 of patients in mild acute pancreatitis group had abnormal main pancreatic duct and %33,3 of patients in moderate pancreatitis group had abnormal main pancreatic duct. It has been found that there was correlation between Ranson scoring system and pancreatic duct morphology observationally but comparison between two groups was not significant statistically (P value was > 0,05).Mean hospital stay time was 11.2±6.94 days in the group with normal pancreatic duct morphology and 10.6±3.71 days were in the group with abnormal pancreatic duct morphology. In the statistical comparison between groups, P value was > 0,05 and was not significant statistically.Mean hospital stay time was 11.2±6.94 days in the mild acute pancreatitis group which has Ranson score between 0 - 3 and 13.6±4.04 days in the moderate acute pancreatitis group which has Ranson score between 4- 5, respectively. In the statistical comparison between groups, P value was > 0,05 and was not significant statistically.Twenty three of 42 patients (54.8%) gave a positive response to medical treatment and no further intervention required. In twelve patients (28.6%) were performed cholecystectomy additionally to medical treatment before discharge. Six of these 12 patients, who were undergoing surgical intervention, were performed laparoscopic cholecystectomy. Open cholecystectomy performed in 6 patients. T tube drainage procedure was added into one patient and choledocoduodenostomy procedure was added into two patient in open cholecystectomy. ERCP was performed to 7 patients in addition to medical treatment.During the follow-up period, pseudocyst observed in 3 patients as a complication. PTC was performed only one in patient who had pseudocyst. Two patient treated conservatively and spontaneous regression observed.Conclusion: As a result of this study we consider that MRCP and MRI is helpful at least up to CT on the follow-up and treatment in acute pancreatitis. We experienced that MRCP evaluated biliary and pancreatic anatomy clearly.According to our data, there was no correlation between pancreatic duct morphology and age, gender, etiology, treatment modality and hospital stay. Complicated cases observed in mild group according to classification based on Ranson scoring system. Also, complicated cases have been observed mainly in the normal morphological group according to MRCP imaging. Therefore it is not possible to comment about the groups in determining the prognosis.Comparing the groups that based on MRCP imaging and Ranson scoring, there was not statistically correlation between these groups and further studies are needed.