Effectiveness of laser therapy in the correction of hepatic encephalopathy depending on the severity of obstructive jaundice of pancreatic origin

Purpose. To study the effectiveness of laser therapy for the correction of hepatic encephalopathy depending on the severity of obstructive jaundice. Materials and methods. 60 patients with acute pancreatitis complicated by the obstructive jaundice of varying severity had clinical and laboratory examination and were prescribed standard and complex therapy. Patients were divided into 4 groups: Group I (n = 15) – patients with a mild form who had standard therapy which included infusion, antispasmodics, painkillers, desensitizers, antibacterial components, enzymatic inhibitors; Group II (n = 15) – patients with a mild form who had standard therapy + laser therapy; Group III (n = 15) – patients with a severe form who had standard therapy; Group IV (n = 15) – patients with a severe form who had standard therapy + laser therapy. Sessions of supravascular laser irradiation were done daily for 7 days, exposure 15 minutes, at the projection of cubital vein as well as at the projection of common carotid and vertebral arteries for 5 minutes at each side with laser device Matrix, CLOS emitting head (wavelength 635 nm, power 2 mW). The functional state of liver was assessed with levels of total and direct bilirubin in the blood, alanine (ALT) activity and aspartic aminotransferase (AST). To verify encephalopathy, psychometric tests were done (tests «Point in a circle» and «Labyrinth»). Results. The psychometric examination revealed impairments of higher brain functions in patients with mechanical jaundice of pancreatogenic origin. When assessing dynamics of some parameters of liver functional status, liver damage signs were seen. As it has turned out, severity of hepatic encephalopathy is associated with the degree of liver damage and severity of jaundice. If supravascular laser blood irradiation was included into the complex treatment, one could see a decrease in encephalopathy symptoms, especially in patients with mild mechanical jaundice. Conclusion. The effectiveness of laser therapy in the correction of encephalopathy in obstructive jaundice depends on the severity of liver damage. In severe liver functional failure, the effectiveness of laser therapy is reduced.

encephalopathy, laser therapy, obstructive jaundice, pancreatitis

1. Aliev N.D., Atarbayeva V. Sh., Popova T.V. Effective management of medical rehabilitation of patients with portal hypertension. Vestnik Kazakhskogo nationalnogo meditzinskogo universiteta. 2018; 1: 61–63. [In Russ.].

2. BabaevA.V., Gogolev D. Ye., Reiner O.V. et al. Effects of intravenous low-level laser blood irradiation at clinical and laboratory indexes of hepatocellular insufficiency. Bulletin Experimentalnoy Biologii and Medicini. 2012; 153 (5): 717–720. [In Russ.].

3. Damulin I.V. Minimal hepatic encephalopathy: modern clinical and pathogenetic aspects. Terapevtichesky archive. 2018; 90 (2): 89–93. [In Russ.].

4. Likhachev S.A., Suprun V.E., Korotkov S.V., DzyadzkoA.M. Hepatic encephalopathy: classification, diagnosis, treatment. Neurology and Neurosurgery. Eastern Europe. 2018; 8 (2): 288–297. [In Russ.].

5. Nikonov E.L., Aksenov V.A. Hepatic encephalopathy. Dokasatelnaya gastroenterologia. 2017; 6 (4): 25–31. [In Russ.].

6. Makarova M.A., Baranova I.A. Differential diagnosis of hepatological syndromes in the practice of a primary care physician. Gastroenerologia. Supplement to the magazine Consilium Medicum. 2017; 2: 69–73. [In Russ.].

7. Moskvina E. Yu., Volkova L.I. Minimal hepatic encephalopathy in liver cirrhosis (a literature review). Uralsky meditzinsky zhurnal. 2017; 10 (154): 44–48. [In Russ.].

8. Pesotskaya K.O. Risk factors for hepatic encephalopathy in patients with hepatobiliary pathology. Sovremennaya gastroenterologia. 2016; 6 (92): 38–42. [In Russ.].

9. Podymova S.D. Hepatic encephalopathy associated with liver cirrhosis. Modern approaches to pathogenesis, clinical picture, treatment. Experimentalnaya i klinicheskaya gastroenterologia. 2017; 11 (147): 4–12. [In Russ.].

10. Polukhina A.V., Khamenova T.Yu., Vinnitskaya E.V. Hepatic encephalopathy: the problem of pharmacotherapy. Meditzinsky sovet. 2018; 3: 43–48. [In Russ.].

11. Sivolap Yu.P. Prevention and treatment of hepatic encephalopathy. Zhurnal nevrologii i psychiatrii Korsakova. 2017; 117 (10): 144–147. [In Russ.].

12. Styazhkina S.N., Isteyeva A.R., Korotkova K.A. et al. Actual problems of obstructive jaundice in surgery. International Journal of Applied and Basic Research. 2016; 7–3: 427–430. [In Russ.].

13. Usmonov U.D., Nishanov F.N., Maksimenkov A.V. et al. Enterosorption, antioxidant therapy and intravenous laser blood irradiation in the complex treatment of obstructive jaundice of non-tumor genesis. Lasernaya medicina. 2011; 15 (1): 19–25. [In Russ.].

14. Arias N., Méndez M., Arias J.L. Low-light-level therapy as a treatment for minimal hepatic encephalopathy: behavioural and brain assessment. Lasers Med Sci. 2016, Nov.; 31 (8): 1717– 1726.

15. KawM., Al-Antably Y., KawP. Management of gallstone pancreatitis: cholecystectomy or ERCP and endoscopic sphincterotomy. J. Hepatobil. Pancreat. Surg. 2013; 9 (4): 429–435.

16. Montagnese S., Bajaj J.S. Impact of Hepatic Encephalopathy in Cirrhosis on Quality-of-Life Issues. Drugs. 2019, Jan 31; 79 (1): 5–9.

17. Rabenstein T., Roggenbuck S., Framke B. Complications of endoscopic sphincterotomy: can heparin prevent acute pancreatitis after ERCP? Gastrointest. Endoscop. 2012; 55 (4): 476–483.

18. Rahimi R.S., Rockey D.C. Hepatic encephalopathy: pharmacological therapies targeting ammonia. Semin Liver Dis. 2016; 36 (1): 48–55.

19. Suda K., Ohtsuka М., Ambiru S. Risk factors of liver dysfunction after extended hepatic resection in biliary tract malignancies. Am. J. Surg. 2009; 197: 752–758.

20. Weissenborn K. Hepatic Encephalopathy: Definition, Clinical Grading and Diagnostic Principles. Drugs. 2019, Jan 31; 79 (1): 11–16.