Abstracts
2000 Digestive Disease Week

# 2317 Evaluation of a New Strategy for Treatment of Severe Acute Pancreatitis.
Yoshifumi Takeyama, Takashi Ueda, Yuichi Hori, Kozo Takase, Yoshikazu Kuroda, Kobe, Japan

Background and Aim: Despite intensive care management, the mortality rate of severe acute pancreatitis is still high. During the first week of hospitalization, patients with severe acute pancreatitis tend to be complicated with multisystem organ failure, and thereafter infection of devitalized pancreatic and/or peripancreatic tissues becomes the most critical complication. In these 8 years, we have experienced 80 cases of severe acute pancreatitis, and in 1995 we adopted a new strategy consisting of selective digestive decontamination (SDD), continuous regional arterial infusion of antiprotease and antibiotic (CRAI) and continuous hemodiafiltration (CHDF). The aim of this paper was to test the clinical efficacy of the new strategy. Patients and Methods: According to Criteria for grading severity formulated by Research Committee of Intractable Disease of Pancreas, Japanese Ministry of Health and Welfare (1990), 80 cases (68%) were classified as severe acute pancreatitis. In this study, we divided these patients chronologically into two groups; Group I (before June 1995, 51 patients), Group II (after July 1995, 29 patients), because we have aggressively introduced SDD, CRAI and CHDF into initial treatment since July 1995. SDD was achieved by continual intrajejunal infusion of lacturose, polymyxin B, amphotericin B and L-glutamine. CRAI was applied to the patients with pancreatic necrosis, and achieved by 5-day continuous infusion of nafamostat mesilate and imipenem into the celiac artery and/or the superior mesenteric artery through the catheter inserted from the femoral artery. CHDF was performed in the patients with progressive remote organ failure. Results: Ranson score and APACHE II score in average were higher in Group II (4.6 and 10.3) than in Group I (3.8 and 9.8). The incidence of remote organ failure was higher in Group II (62.1%) than in Group I (54.9%). However, operation due to infectious complications was performed more frequently in Group I (24 patients, 47%) than in Group II (5 patients, 17%). Nineteen patients (37%) in Group I and 8 patients (28%) in Group II died. Twelve patients in Group I and 4 patient in Group II died of sepsis, and 3 in Group I and 2 in Group II died of multiple organ failure in the early stage of the disease. Conclusions: The new strategy lowered mortality through preventing infectious complication. Although SDD and CRAI lowered incidence of infection, we still have patients with infectious complications. Moreover, multisystem organ failure in the early stage remains sometimes fatal.