ТREATMENT OF SEVERE ACUTE PANCREATITIS

  • Ivan R Praznik Klinički centar Kragujevac, Opšta hirurgija
Keywords: Mortality, Complications, Treatment, Acute Pancreatitis,

Abstract


Acute  pancreatitis  is  an acute  inflammatory process of  the pancreas with variable involvement of other regional tissues or  other organ systems. The severe form of the disease occurs in 10-20% of cases, and

usually  requires  prolonged  hospitalization due  to  a  frequent  local  and  systemic complications. Additionally, considerable  mortality despite  diagnostic  and  therapeutic  advances,  makes  this  disease  a serious  health

problem nowadays. The aim of this study was to conduct a review of randomized controlled trials to determine  differences in the  efficiency  between  standard  methods  of  treatment for severe acute pancreatitis and new treatment  ways in  terms  of  decreased mortality.

Search of the "Medline" database  of  original  scientific  papers  and  systematic   review  articles was made, using a combination of  the following keywords: acute pancreatitis,  treatment,  mortality. In  total  914  papers were found,  published  in  the  last 13 years; 14 of 64 randomized controlled  clinical  trials  met  the  selection  criteria  and  were  eligible  for  inclusion. From a total of 16 papers, the  conservative  treatment  was  related  to 11, which  includes  some of   the  new  treatment methods, while the effects of new methods of treatment have been the subject of research in the four studies. Combined endoscopic  and  surgical  treatment  was  applied  in only one  study. The  largest  sample  of  290  patients  was  included  in the study  with  platelet  activation  factor  antagonist, while  the  smallest sample of 22 patients was used in the study that compared total parenteral with enteral nutrition.

Continuous regional arterial infusion of protease inhibitors in combination with antibiotics, intravenous supplementation of alanyl-glutamine dipeptide  and  the early,  high-volume continuous  veno-venous  hemofiltration showed  the best  results in the treatment of patients with severe acute pancreatitis. Also, the use of  low molecular  weight  heparin  and  enteral  nutrition  significantly  reduced  mortality.

Author Biography

Ivan R Praznik, Klinički centar Kragujevac, Opšta hirurgija
Dr med. Klinički lekar

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Published
2014/03/27
Section
Review Paper