Experience in treating patients with autoimmune pancreatitis

Abstract

OBJECTIVE — to establish the main diagnostic signs of autoimmune pancreatitis and aspects of patient treatment. MATERIALS AND METHODS. The study analyzed the results of examination and treatment of 17 patients with autoimmune pancreatitis (AIP) from 2010 to 2022. Among the total number of patients with AIP, there were 11 men (65 %) and 6 women (35 %). The average age of the patients was 52.4 years. Among all patients with AIP, focal involvement of the pancreas was found in 3 (18 %) patients, with a predominant involvement of the head of the pancreas. Segmental form of AIP was diagnosed in 6 (35 %) patients, while diffuse form was found in 8 (47 %) patients. Type 1 AIP was identified in 13 (76 %) patients, and type 2 AIP in 4 (24 %) patients. For all patients suspected of AIP, the HISORt criteria were assessed: instrumental visualization, serological and histological verification, determination of the volume of pancreatic involvement, and response to steroid therapy. RESULTS. Recurrence of AIP was observed in 8 (47.0 %) patients with type 1 AIP and 1 (5.8 %) patient with type 2 AIP. AIP recurred in patients with proximal bile duct involvement, diffuse pancreatic involvement, persistently elevated IgG4 levels after steroid induction, delayed radiological remission, and damage to more than two organs. Increased serum levels of IgG, IgG4, apnd eosinophilia indicated a recurrence of IgG4-RD. A repeat induction of steroids was performed in patients with recurrent AIP, which proved to be very effective, resulting in high remission rates, specifically in 7 (70 %) patients with type 1 AIP and in 1 (100 %) patient with type 2 AIP. Among all AIP patients that were operated on, 3 (40 %) underwent Roux-en-Y hepaticojejunostomies, 1 (20 %) pancreaticoduodenectomy, and 1 (20 %) a Frey procedure. CONCLUSIONS. The low incidence of AIP necessitates the use of a clear diagnostic algorithm, and the peculiarities of the disease’s course require compliance with all the principles of conservative treatment and surgical interventions in case of surgical complications.