Therapeutic efficacy of continuous arterial infusion of the protease inhibitor and the antibiotics and via celiac and superior mesenteric artery for severe acute pancreatitis--pilot study.
OBJECTIVE
Severe acute pancreatitis is poor prognosis. Continuous regional arterial infusion of protease inhibitors and antibiotics were developed in Japan. We evaluated whether arterial infusion both celiac artery and superior mesenteric artery for this disease would reduce mortality.


METHODS
Seventeen patients were treated arterial infusion of protease inhibitor and antibiotics via both celiac artery and superior mesenteric artery. Changes of Acute Physiology and Chronic Health Evaluation II score and mortality were evaluated.


RESULTS
Arterial infusion via two routes reduced the mortality rate and improved Acute Physiology and Chronic Health Evaluation II score. The overall mortality rate was 11.8%. The mortality rate in patients in whom were treated within 3days after the onset was significantly lower than that in patients in whom were treated without 3days after the onset.


CONCLUSIONS
Arterial infusion via superior mesenteric artery might prevent both bacterial translocation and non-occlusive mesenteric ischemia. Continuous arterial infusion both celiac artery and superior mesenteric artery might be effective for reducing mortality and preventing the development of pancreatitis, especially when initiated within 3 days after the onset. Further prospective randomized studies using a larger number of patients are required.
Ishikawa
Toru
T
Department of Gastroenterology, Saiseikai Niigata Second Hospital, Niigata, Japan. toruishi@ngt.saiseikai.or.jp
Imai
Michitaka
M
Kamimura
Hiroteru
H
Ushiki
Takashi
T
Tsuchiya
Atsunori
A
Togashi
Tadayuki
T
Watanabe
Kouji
K
Seki
Kei-ichi
K
Ohta
Hironobu
H
Yoshida
Toshiaki
T
Kamimura
Tomoteru
T
D018806:APACHE; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002445:Celiac Artery; D005260:Female; D006801:Humans; D007261:Infusions, Intra-Arterial; D007564:Japan / Q000453:epidemiology; D008297:Male; D017538:Mesenteric Artery, Superior; D008875:Middle Aged; D010195:Pancreatitis / Q000188:drug therapy* / Q000401:mortality; D010865:Pilot Projects; D011480:Protease Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D011480:Protease Inhibitors