Surgical and personalized aspects of correction of biliary-pancreatic duct hypertension: treatment outcomes and a novel approach

Objective. To investigate treatment options and present a rationale for a novel approach to biliary-pancreatic hypertension considering potentials for personalization. Material and methods. Study design implies a case series. Data from 2024 were analyzed. There were 596 patients with cholelithiasis and its complications, as well as 48 patients with chronic pancreatitis and pancreatic cysts. Biliary hypertension was observed in 28% (167/596) of cases, pancreatic hypertension — in 89.6% (43/48) cases. Results. Minimally invasive procedures were performed in 94.6% (158/167) of patients with biliary hypertension and 93.7% (45/48) with pancreatic lesions. Bile duct drainage was performed in 68.9% (115/167) including transpapillary drainage in 96.5% (111/115) of these cases. Pancreatic duct drainage was performed in 85.4% (41/48) of patients including transpapillary drainage in 90.2% (37/41) of these patients. In-hospital mortality for patients with biliary hypertension was 1.2% (2/159), while no fatal outcomes were observed for patients with pancreatic hypertension. Pancreatitis after transpapillary interventions was observed in 6.2% of patients with biliary-pancreatic hypertension. Complications requiring laparoscopic or open surgery occurred in 2.4% of cases. Experience of transpapillary interventions and intraductal drug administration supports investigation of a new combined approach including surgery and target effect on PIEZO1 mechanoreceptors. Conclusion. Molecular-genetic data on biliary-pancreatic hypertension necessitate research of a novel approach. Effectiveness of this method can be evaluated through prospective clinical trials.