Abstract
INTRODUCTION: Acute pancreatitis (AP) is one of the most common gastrointestinal diseases, imposing a significant burden on patients, with its incidence steadily increasing worldwide. Despite a drop in fatality rates, AP-related complications remain high, impacting prognosis. OBJECTIVES: This retrospective clinical study introduces the concept of "bile transfer" (BT) and explores its potential in reducing AP-related complications. METHODS: This single-center, retrospective cohort study evaluated 344 AP patients with gallbladder distension at our hospital from January 2019 to December 2024. Patients were classified into three groups: percutaneous transhepatic gallbladder drainage (PTGD) + bile reinfusion (BT group), PTGD-alone, and conventional treatment to assess complication rates. Logistic regression identified independent risk factors for treatment outcomes. Restricted cubic splines (RCS) were employed to identify optimal indications for BT. RESULTS: Among the 344 patients, the incidence of new complications in the BT group was 21.50 %, significantly lower than in the PTGD-alone (46.59 %) and conventional treatment groups (54.36 %) (p < 0.001). Logistic regression identified Total bilirubin (TBIL), Ca(2+), White blood cell (WBC), and Aspartate aminotransferase (AST) / Alanine aminotransferase (ALT) as independent predictors of poor BT outcomes. RCS analysis showed TBIL < 23.6 μmol/L, WBC < 10.6 × 10(9)/L, and Ca(2+)>2.12 mmol/L as optimal indicators for BT use. CONCLUSION: This study introduces BT and shows that PTGD combined with bile reinfusion significantly reduces complications in AP patients. We identified optimal indications and predictors for BT. These findings are clinically important for improving AP patient prognosis.