Treatment of Microcirculatory Disturbances in Acute Pancreatitis

Abstract

Acute pancreatitis is a serious inflammatory condition. Research has shown an increase in the number of pancreatitis-associated hospitalizations, with a marked decline in the mortality rates down to 0.79% in patients with acute pancreatitis and 0.26% in patients with exacerbation of chronic pancreatitis. Up to one-third of patients develop pancreatic tissue necrosis, with a mortality rate of 30%. One of the mechanisms is the disturbances in pancreatic microcirculation due to the release of endothelin, a long-acting vasoconstrictor. The development of pancreatitis causes the release of other inflammatory mediators, which reduce blood flow in the microcirculation. The activation of intracellular trypsinogen initiates a cascade of mechanisms in pancreatitis. There is no specific treatment for acute pancreatitis. Protease inhibitors are not effective in treating severe acute pancreatitis. There is an important role of low-molecular-weight heparin in attenuating necrosis and restoring perfusion of the pancreas. Other drugs used are endothelin receptor antagonists, antagonist of interleukin-1 and interleukin-6 receptors, α-tocopherol, tumor necrosis factor-α and platelet-activating factor inhibitors, acetylsalicylic acid, and local intra-arterial injection of lidocaine. The prophylactic use of antibiotics is not recommended. The treatment outcome of acute pancreatitis is still unsatisfactory.

Radiomics models of contrast-enhanced computed tomography for predicting the activity and prognosis of acute pancreatitis

“…Compared to CTSI and EPIC, radiomics model had a superior value. It suggested that radiomics features revealed some of the differences between high and low level of disease activity, which was possibly due to some small morphological changes in pancreatic parenchyma caused by hemoconcentration, decreased blood flow, decreased tissue oxygenation decreased, vasoconstriction or increased permeability [ 26 , 27 ].…”

Moderate level platelet count might be a good prognostic indicator for intra-abdominal infection in acute pancreatitis: A retrospective cohort study of 1,363 patients

“…The mechanism of platelet count on intra-abdominal infection is poorly understood, but several explanations could be considered. The inflammatory process results in disturbances in pancreatic microcirculation, which has been recognized as an important factor in the development of acute pancreatitis ( 20 ). The ultra-structural changes in acute pancreatitis, including the infiltration of leukocytes, the accumulation of platelets intravascularly and extravascularly, and the formation of microthrombi, could be observed ( 21 ).…”

Detection value of endoscopic ultrasound-guided 19G fine-needle wet-heparinized suction for pancreatic solid tumors: a randomized controlled trial

“…Subsequent studies ( 8 , 12 ) have adopted heparin for EUS-guided fine-needle liver biopsy and discovered that heparin prevented the adhesion of tissue strips to the needle tubing wall because of blood coagulation, thus increasing the amount of obtained specimen. A recent study has explored the merits of wet-heparinized pancreas biopsy ( 17 ), but there is currently no data available to explore its effect on the quality of pancreatic specimens. Our study found that the heparin group had longer pancreatic tissue strips than the conventional group (P<0.05), which indicated that the coagulative activity of heparin increased the sample yield in the pancreatic biopsies.…”

“…Severe fibrosis in the pancreatic peritumoral tissues can cause the white tissue strips to mingle with segmental fibrotic tissues ( 10 , 17 , 23 ), leading to bias in the MOSE. Therefore, additional laboratory diagnosis is essential.…”