La Pancreatite Acuta.
La Terapia con Antienzimi :
Utilità e Modalità
Prof. Roberto Testa
Pathophysiology and Clinical Phases
of Acute Pancreatitis
Pezzilli et al, Ospedali Italiani Chirurgia 2004
Basic Management of Acute Pancreatitis
Pezzilli et al, J Pancreas 2006
Serum Amylase Levels before and after
Endoscopic Procedures in Patients
Treated with Gabexate or Placebo
Cavallini et al, New Engl Journ 1996
Main characteristics of the 3 largest trials
on the Prophylaxis of post-ERCP Pancreatitis
by the administration of Gabexate or
Somatostatin
Cavallini, 1996
Poon, 1999
Andriulli, 2002
Placebo
(mannitol
NaCl)
Gabexate
Placebo
Saline
Somatost
atin
Placebo
Saline
Gabexate
Somatost
atin
12
12
12
12
2.5
2.5
2.5
-
1 gr
83 mg
Saline/
5%glucose
-
-
0.5 g
200 mg
Saline
0.75 mg
300 µg
Saline
Incidence of postERCP pancreatitis
8%
2%
10%
30%
6.5%
8.1%
Severe type
31%
0%
0%
0%
0.5%
0.5%
Protocol
Infusion time (h)
Active drug:
- Total dosage
- Hourly dosage
- Dissolved in:
3 mg
250 µg
Saline
11.5%
Andriulli et al, JOP 2003
Treatment of acute Pancreatitis with
Protease Inhibitors
Seta et al, Eur J Gastroenterol Hepatol 2004
Gastrointestinal Actions of
Natural Somatostatin
Prophylactic administration of Somatostatin for
post-ERCP Pancreatitis
Andriulli et al, JOP 2003
Randomized Trials on Medical Treatment for Severe AP
Reference
n
Treatment
Need
for surgery
Sepsis
MOF
Mortality
Buchler 1995
115
108
Gabexate
Placebo
22%
21%
-
-
16%
15%
Chen 2000
26
26
Gabexate
Control
25.9%
50%
-
-
7.7%
30.7%
Johnson 2001
148
138
Lexipafant
Placebo
-
3%
9%
57%
58%
10%
15%
McKay 1997
26
24
Lexipafant
Placebo
-
-
18.2%
33.3%
11.5%
25%
Uhl 1999
98
101
103
Octreotide
Octreotide
Placebo
13%
14%
18%
4.1%
5%
3.9%
-
15%
12%
6%
Paran 2000
25
25
Octreotide
Placebo
-
24%
76%
8%
12%
8%
32%
Planas 1998
24
22
Octreotide
Placebo
37.5%
63.3%
87.5%
90.9%
-
38%
32%
McKay 1997
28
30
Octreotide
Placebo
-
10.7%
17.9%
13.3%
20%
Heinrich et al, Annal of Surgery 2006
Infliximab in Acute PAncreatitis
Oruc et al, Pancreas 2004
Lanreotide after Oral Refeeding in
Patients with Necrotizing Acute Pancreatitis
Levy et al, Pancreatology 2004
A Critical Appraisal of the Clinical
Trials in Acute Pancreatitis
Norman, Am J Surg 1998
The Therapeutic Window
Norman, Am J Surg 1998
Treatment of Acute PAncreatitis
Pezzilli et al, J Pancreas 2006