Retrospective Cohort Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jul 27, 2015; 7(7): 110-115
Published online Jul 27, 2015. doi: 10.4240/wjgs.v7.i7.110
Capillary refill time as a guide for operational decision-making process of autoimmune pancreatitis: Preliminary results
Pinar Yazici, Ismail Ozsan, Unal Aydin
Pinar Yazici, Department of General Surgery, Sisli Etfal Training and Research Hospital, 34371 Istanbul, Turkey
Ismail Ozsan, Unal Aydin, Department of General Surgery, Izmir University, Medical Park Hospital, 35000 Izmir, Turkey
Author contributions: Yazici P and Aydin U contributed to the conception and design, acquisition of data, or analysis and interpretation of data; Yazici P and Ozsan I drafted the article or revising it critically for important intellectual content; Yazici P and Aydin U made the final approval of the version to be published.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Izmir University School of Medicine.
Informed consent statement: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There is none to declare.
Data sharing statement: Technical appendix and dataset available from the corresponding author at drpinaryazici@gmail.com. No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Pinar Yazici, MD, Department of General Surgery, Sisli Etfal Training and Research Hospital, Halaskargazi cad. Etfal Sok, 34371 Istanbul, Turkey. drpinaryazici@gmail.com
Telephone: +90-505-5784185
Received: January 27, 2015
Peer-review started: January 28, 2015
First decision: April 10, 2015
Revised: April 20, 2015
Accepted: May 16, 2015
Article in press: May 18, 2015
Published online: July 27, 2015
Processing time: 180 Days and 18.1 Hours
Abstract

AIM: To investigate the efficacy of a novel intraoperative diagnostic technique for patients with preliminary diagnosis of autoimmune pancreatitis (AIP).

METHODS: Patients with pancreatic surgery were reviewed to identify those who received a preliminary diagnosis of AIP between January 2010 and January 2014. The following data were collected prospectively for patients with a pathological diagnosis of AIP: clinical and demographic features, radiological and operative findings, treatment procedure, and intraoperative capillary refill time (CRT) in the pancreatic bed.

RESULTS: Eight patients (six males, two females; mean age: 51.4 years) met the eligibility criteria of pathologically confirmed diagnosis. The most frequent presenting symptoms were epigastric pain and weight loss. The most commonly conducted preoperative imaging studies were computed tomography and endoscopic retrograde pancreaticodoudenography. The most common intraoperative macroscopic observations were mass formation in the pancreatic head and diffuse hypervascularization in the pancreatic bed. All patients showed decreased CRT (median value: 0.76 s, range: 0.58-1.35). One-half of the patients underwent surgical resection and the other half received medical treatment without any further surgical intervention.

CONCLUSION: This preliminary study demonstrates a novel experience with measurement of CRT in the pancreatic bed during the intraoperative evaluation of patients with AIP.

Keywords: Autoimmune pancreatitis; Pancreatic mass; Inflammation; Hypervascularity; Capillary refill time

Core tip: Autoimmune pancreatitis is still a diagnostic dilemma, and there is a way to go, especially differentiating from pancreatic malignancy. Hence the debate: to cut or to observe. We hypothesized that this infrequent inflammatory event causes increased vascularity on pancreatic tissue. Thus, we aimed to display whether there was a remarkable vascularity on the pancreatic surface or not by using capillary refill time. Preliminary results showed decreased capillary refill time demonstrating hypervascularity on the pancreatic surface and this inspired that capillary refill time could be an additional tool to guide the operational decision-making process of autoimmune pancreatitis.