Early intraperitoneal metabolic changes and protease activation as indicators of pancreatic fistula after pancreaticoduodenectomy

Ansorge, Christoph; Regnér, Sara; Segersvärd, Ralf; Strömmer, Lisa

doi:10.1002/bjs.7730

Cited by 39 publications

(35 citation statements)

References 26 publications

(19 reference statements)

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“…Metabolic profiling of predictive biomarkers has also been attempted. [ 97 ] A fluorescent-based chymotrypsin detection probe was able to detect increased enzyme in pancreatic fluid, which correlated with development of fistulae. [ 98 ] Validation and generalized availability hampers the daily use of these promising techniques.…”

Section: Resultsmentioning

confidence: 99%

Risk factors and preventive strategies for post-operative pancreatic fistula after pancreatic surgery: a comprehensive review

Søreide

Labori

2016

Scandinavian Journal of Gastroenterology

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Background: Pancreas surgery has developed into a fairly safe procedure in terms of mortality, but is still hampered by considerable morbidity. Among the most frequent and dreaded complications are the development of a post-operative pancreatic fistula (POPF). The prediction and prevention of POPF remains an area of debate with several questions yet to be firmly addressed with solid answers. Methods: A systematic review of systematic reviews/meta-analyses and randomized trials in the English literature (PubMed/MEDLINE, Cochrane library, EMBASE) covering January 2005 to December 2015 on risk factors and preventive strategies for POPF. Results: A total of 49 systematic reviews and meta-analyses over the past decade discussed patient, surgeon, pancreatic disease and intraoperative related factors of POPF. Non-modifiable factors (age, BMI, comorbidity) and pathology (histotype, gland texture, duct size) that indicates surgery are associated with POPF risk. Consideration of anastomotic technique and use of somatostatin-analogs may slightly modify the risk of fistula. Sealant products appear to have no effect. Perioperative bleeding and transfusion enhance risk, but is modifiable by focus on technique and training. Drains may not prevent fistulae, but may help in early detection. Early drain-amylase may aid in detection. Predictive scores lack uniform validation, but may have a role in patient information if reliable pre-operative risk factors can be obtained. Conclusions: Development of POPF occurs through several demonstrated risk factors. Anastomotic technique and use of somatostatin-analogs may slightly decrease risk. Drains may aid in early detection of leaks, but do not prevent POPF.

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Section: Resultsmentioning

confidence: 99%

Risk factors and preventive strategies for post-operative pancreatic fistula after pancreatic surgery: a comprehensive review

Søreide

Labori

2016

Scandinavian Journal of Gastroenterology

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“…The placement of specially developed MD probes in the pancreas using transgastric echoendoscopic insertion could be a potential method [16]. The clinical usefulness of MD was recently demonstrated in a study of patients with pancreaticojejunal anastomosis, since the retrieval and analysis of intraperitoneal exudate by MD allowed the early detection of fistula formation [17]. …”

Section: Discussionmentioning

confidence: 99%

Microdialysis in Early Detection of Temporary Pancreatic Ischemia in a Porcine Model

et al. 2012

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Background: Ischemic injury to the pancreas occurs in various clinical conditions. A method for online monitoring of pathophysiological events in pancreatic parenchyma is missing. Aims: To assess the timing of microdialysis (MD) technique response on temporary changes in pancreatic perfusion, and to evaluate the relationship between MD data and systemic markers of anaerobic metabolism and inflammation. Methods: In anaesthetized normoventilated pigs, MD probes were placed in right (control) and left (ischemic) pancreatic lobes, respectively. Following the clamping of the vessels, ischemia was verified by tissue oxygen tension (P_tiO₂) measurements. Results: P_tiO₂ decreased within 20 min after the clamping of the vessels, already returning to baseline levels at the first sampling point after the removal of the clamp. MD lactate levels increased, whereas pyruvate and glucose levels decreased at 20 min after the induction of ischemia. These trends continued until the end of ischemia and returned to baseline following reperfusion. Serum lactate, amylase and tumor necrosis factor-alpha levels decreased throughout the protocol time. Conclusion: MD data were in concordance with changes in P_tiO₂, which is indicative of local anaerobic metabolism. MD allowed the detection of pathophysiological processes within the ischemic pancreas at a stage when no elevations of systemic markers of ischemia or inflammation were observed.

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“…It has previously been shown that patients who develop pancreatic fistula following Whipple’s procedure have a high concentration of postoperative intraperitoneal glycerol [29], which may be due to leakage of pancreatic enzymes into the abdominal cavity. This could also be the explanation for higher levels of glycerol concentration seen in patients with upper GI perforation compared with patients with lower GI perforation.…”

Section: Discussionmentioning

confidence: 99%

Intraperitoneal lactate/pyruvate ratio and the level of glucose and glycerol concentration differ between patients surgically treated for upper and lower perforations of the gastrointestinal tract: a pilot study

et al. 2017

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BackgroundSecondary peritonitis is a condition associated with high morbidity and mortality. Continuous postoperative monitoring of patients to ensure timely intervention to treat complications without delay is important for survival and outcome. We aimed to (1) investigate potential differences in postoperative intraperitoneal biomarker levels between patients with upper and lower gastrointestinal tract lesion, and (2) compare postoperative biomarker levels between complicated and uncomplicated patients.MethodsWe included a total of 15 consecutive patients operated for upper (n = 7) and lower (n = 8) gastrointestinal tract perforation. We registered postoperative complications during a 30 days follow up-period. Complications were defined as intraabdominal complications, septic shock, and mortality. 5 patients were complicated. A microdialysis catheter was placed intraperitoneally in each patient. Samples were collected every 4th hour for up to 7 postoperative days. Samples were analysed for concentrations of glucose, lactate, pyruvate and glycerol.ResultsMicrodialysis results showed that patients with upper gastrointestinal tract lesions had significantly higher levels of postoperative intraperitoneal glucose and glycerol concentrations, as well as lower lactate/pyruvate ratios and lactate/glucose ratios. In the group with perforation of the lower gastrointestinal tract, those patients with a complicated course showed lower levels of postoperative intraperitoneal glucose concentration and glycerol concentration and higher lactate/pyruvate ratios and lactate/glucose ratios than those patients with an uncomplicated course.ConclusionPatients with upper and lower gastrointestinal tract lesions showed differences in postoperative biomarker levels. A difference was also seen between patients with complicated and uncomplicated postoperative courses.

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Early intraperitoneal metabolic changes and protease activation as indicators of pancreatic fistula after pancreaticoduodenectomy

Cited by 39 publications

References 26 publications

Risk factors and preventive strategies for post-operative pancreatic fistula after pancreatic surgery: a comprehensive review

Risk factors and preventive strategies for post-operative pancreatic fistula after pancreatic surgery: a comprehensive review

Microdialysis in Early Detection of Temporary Pancreatic Ischemia in a Porcine Model

Intraperitoneal lactate/pyruvate ratio and the level of glucose and glycerol concentration differ between patients surgically treated for upper and lower perforations of the gastrointestinal tract: a pilot study

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