Continuous Regional Arterial Infusion of Protease Inhibitors for Treatment of Severe Acute Pancreatitis: Systematic Review and Meta-Analysis.
OBJECTIVE
We performed a systematic review and meta-analysis of observational studies and randomized controlled trials (RCTs) to assess the benefit and risk of continuous regional arterial infusion (CRAI) of protease inhibitors (CRAIpis) in patients with severe acute pancreatitis (SAP) or acute necrotizing pancreatitis (ANP).


METHODS
The search was performed using the key words "pancreatitis" and "regional arterial infusion." All language studies involving adult cases of SAP or ANP, which assessed the impact of the CRAIpis, were included.


RESULTS
Our analysis included 8 observational studies and 2 RCTs from 376 potentially relevant articles. With regard to the observational studies, the CRAIpi was significantly associated with decreased both mortality (odds ratio, 0.40; 95% confidential interval [CI], 0.25-0.64; P = 0.0001) and the need for urgent surgical intervention (odds ratio, 0.22; 95% CI, 0.12-0.3; P < 0.0001). In the RCTs, the application of CRAIpi tends to decrease the mortality but does not reach the significance (risk reduction, -0.12; 95% CI, -0.36-0.12; P = 0.33).


CONCLUSIONS
The CRAIpi has the potential to reduce the mortality or the need for urgent surgical intervention in cases of SAP or ANP. Further, large multicenter trials are needed to refute or confirm our findings.
From the *Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo; †Department of Anesthesiology and Intensive Care, Kobe University Hospital, Hyogo; ‡Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo; and §Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan.
Masayasu
M
Horibe
Moritoki
M
Egi
Mitsuhito
M
Sasaki
Masamitsu
M
Sanui
D000208:Acute Disease; D006801:Humans; D007261:Infusions, Intra-Arterial; D064887:Observational Studies as Topic; D010195:Pancreatitis / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D011480:Protease Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome
D011480:Protease Inhibitors