Controlled Clinical Trial of Peritoneal Lavage for the Treatment of Severe Acute Pancreatitis

Abstract

We performed a multicenter, randomized, controlled clinical trial of therapeutic peritoneal lavage (2 liters per hour for three days) in 91 patients with severe acute pancreatitis. Patients were entered into the study if severe pancreatitis was indicated by multiple laboratory criteria or diagnostic peritoneal lavage. All patients received full supportive treatment. The median time between the onset of symptoms and randomization was 38 hours. Forty-six patients were assigned to the control group and 45 to the lavage group. There were 13 deaths (28 per cent) and 16 patients with major complications (35 per cent) in the control group, as compared with 12 deaths (27 per cent) and 17 patients with major complications (38 per cent) in the lavage group. Lavage did not appear to modify the length of survival, the incidence of pancreatic collections (pseudocysts or abscesses), or the plasma amylase concentration. Considering the statistical power of the design, we conclude that the outcome of severe pancreatitis was not greatly, if at all, influenced by the regimen of peritoneal lavage used in this study.

Usefulness of Early-phase Peritoneal Lavage for Treating Severe Acute Pancreatitis

“…Infected pancreatic necrosis develops in approximately 20% of patients with severe acute pancreatitis, with a mortality rate of approximately 30% (19). A few randomized controlled trials have reported that peritoneal lavage does not reduce the incidence of complications; however, in these reports, the duration of peritoneal lavage was only four days or less (13,15). In contrast, in the present study, the median duration of peritoneal lavage was seven days, and the incidence of infected pancreatic necrosis was 4%.…”

“…Peritoneal lavage was started within 72 hours from the initial onset of symptoms in 20 patients (87%). The duration of peritoneal lavage was seven (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) days. The duration of peritoneal lavage was correlated with the SIRS score (r=0.52; p=0.036), number of prognostic factors according to the revised Japanese criteria (r=0.70; p= 0.0054), Ranson score (r=0.49; p=0.049) and serum Creactive protein level (r=0.65; p=0.0096) at the start of peritoneal lavage.…”

“…Peritoneal lavage decreases not the ascitic, but rather the serum, levels of proinflammatory cytokines and pancreatic enzymes (9,13). In addition, longterm (seven days), but not short-term (two or three days), peritoneal lavage has been reported to reduce the incidence of sepsis and the rate of death from sepsis among patients with severe acute pancreatitis (14,15). Therefore, we speculate that peritoneal lavage for the period appropriate to the severity of the disease reduces the mortality rate of severe acute pancreatitis.…”

Peritoneal Dialysis in Acute Renal Failure

“…However a multicenter, prospective, randomised, controlled trial of patients who received standard supportive therapy with or without hourly two litre peritoneal dialysis exchanges for three days found no difference in mortality or complication rates (26). Thus, the supposed beneficial effects of peritoneal dialysis in acute pancreatitis (27) are a matter of controversy and the beneficial effect of the addition to the peritoneal dialysis solution of antibiotics or antiproteinases remains speculative.…”

Treatment of Acute Pancreatitis: An Attempted Historical Review

“…Eight randomized prospective clinical trials evaluating the influence of continuous peritoneal lavage in patients with acute pancreatitis were performed, but led to divergent results [38,39,40,41,42,43,44,45]. A meta-analysis, however, showed that this therapeutic procedure was not associated with any improvement in mortality or morbidity [46].…”