Treatment outcome of selective digestive decontamination and enteral nutrition in patients with severe acute pancreatitis.
OBJECTIVE
Sepsis due to infected pancreatic necrosis is the most serious complication in the late phase of severe acute pancreatitis (SAP). Bacterial translocation from the gut is thought to be the main cause of pancreatic infection. The possibility has recently been reported that selective digestive decontamination (SDD) and enteral nutrition (EN) may alleviate the complications and reduce the mortality rate in patients with SAP. We analyzed the treatment outcome of SDD and EN in patients with SAP.


METHODS
We divided 90 patients with SAP into three groups: SDD(-)EN(-),group A; SDD(+)EN(-), group B; and SDD(+)EN(+), group C. Clinical outcome was analyzed retrospectively. The effect of SDD was compared in groups A and B, and the effect of EN was compared in groups B and C.


RESULTS
The background of patients was not significantly different between the groups. SDD reduced the incidence of organ dysfunction (from 70% to 59%) and the mortality rate (from 40% to 28%), but the differences were not significant. EN reduced the incidence of infected pancreatic necrosis (from 31% to 24%) and the frequency of surgery for pancreas (from 28% to 18%), and further reduced the mortality rate (from 28% for SDD to 16%), but the differences were not significant. The peripheral lymphocyte count was significantly increased in patients with EN.


CONCLUSIONS
SDD and EN did not significantly affect the treatment outcome in SAP. However, the results in this study raise the possibility that SDD and EN may decrease the complications and reduce the mortality rate in SAP. The efficacy of SDD and EN for SAP should be evaluated in a randomized controlled trial.
Sawa
Hidehiro
H
Department of Gastroenterological Surgery, Kobe University Graduate School of Medical Sciences, Kobe, 650-0017, Japan.
Ueda
Takashi
T
Takeyama
Yoshifumi
Y
Yasuda
Takeo
T
Shinzeki
Makoto
M
Matsumura
Naoki
N
Nakajima
Takahiro
T
Matsumoto
Ippei
I
Fujita
Tsunenori
T
Ajiki
Tetsuo
T
Fujino
Yasuhiro
Y
Kuroda
Yoshikazu
Y
D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D004203:Disinfection / Q000379:methods*; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D006801:Humans; D007564:Japan; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D019283:Pancreatitis, Acute Necrotizing / Q000150:complications / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D018805:Sepsis / Q000209:etiology / Q000517:prevention & control*; D012720:Severity of Illness Index; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents