Acute pancreatitis possible initial triggering mechanism and prophylaxis.
OBJECTIVE
Biliary acute pancreatitis or postendoscopic iatrogenia acute pancreatitis (AP) are likely triggered by autonomous arc reflexes (AAR) initiated in the peri-Vaterian duodenum (PV-D). The bilio-pancreatic duct outlet exclusion closed duodenal loops (BPDOE-CDL) model mimics these circumstances. Our aim was to validate this model and evaluate the role of AAR via their interruption with local anesthetics.


METHODS
Severe AP was induced in Wistar rats with the BPDOE-CDL model: extra-pancreatic insult was provoked in the PV-D by distension with 8% sodium taurocholate and methylene blue for 45 min to show the absence of duodenum pancreatic reflux. Treated experimental groups received a 2% lidocaine chlorhydrate gel instilled into the PV-D prior to triggering the AP, or before and after at the celiac-ganglia complex, or at both sites. The degree of severity was evaluated using biochemical and histopathological analysis.


RESULTS
Induction of AP by BPDOE- CDL was severe, with acinar and fat necrosis and hemorrhage with a greater foci number in the cephalic segment. Groups pretreated with local anesthetic developed mild or moderate AP characterized by edema and leukocyte infiltrate. Serum amylase, lipase and CRP were significantly reduced in all treated groups. Other blood metabolites and pancreatic myeloperoxidase, amylase and lipase, were significantly decreased.


CONCLUSIONS
The BPDOE-CDL model was validated, emphasizing the importance of AAR as extrapancreatic initiators of AP. The interruption of AAR by lidocaine chlorhydrate prevented excessive pancreatic inflammation and diminished hemorrhage and necrosis and may prove a useful prophylactic procedure to prevent postendoscopic severe AP.
Cosen-Binker
Laura Iris
LI
Programa de Estudios Pancreáticos, Hospital de Clínicas, Facultada de Farmacia y Bioquímica, Universidad de Buenos Aires, Argentina. cosbin@sickkids.ca
Binker
Marcelo Gustavo
MG
Negri
Gustavo
G
Tiscornia
Osvaldo
O
D000208:Acute Disease; D000779:Anesthetics, Local / Q000627:therapeutic use; D000818:Animals; D004195:Disease Models, Animal; D004386:Duodenum / Q000601:surgery; D008012:Lidocaine / Q000627:therapeutic use; D008297:Male; D010179:Pancreas / Q000187:drug effects / Q000378:metabolism / Q000473:pathology*; D010195:Pancreatitis / Q000188:drug therapy / Q000473:pathology* / Q000517:prevention & control*; D051381:Rats; D017208:Rats, Wistar; D012018:Reflex; D017833:Visceral Afferents / Q000503:physiopathology
D000779:Anesthetics, Local; D008012:Lidocaine