Abstracts
1998 Digestive Disease Week

#1014

INFLUENCE OF CONTRAST MEDIUM AND OCTREOTIDE ON THE DEVELOPMENT OF PANCREATIC NECROSIS. W.Uhl, M.W.Büchler and the German Pancreatitis Study Group, Department of Visceral and Transplantation Surgery, University Hospital of Bern, CH 3010 Bern, Switzerland.

In experimental acute pancreatitis, a negative effect of both contrast medium (Ann Surg 221, 257 - 264, 1995) and of Octreotide (Langenbeck Arch Chir, Forum Band 1997, 407 - 411) on the progress of pancreatic necrosis has been found. In the randomized controlled trial using Octreotide in acute pancreatitis this effect was analyzed. Patients and methods: In the doubleblind, placebo controlled, randomized multicentric study a total of 302 patients with moderate to severe acute pancreatitis from 32 centers between 11/1993 until 4/1996 were included (198 male, 104 female, mean age 50 years with a range of 18 - 93 years). CT findings at inclusion to the study and the worst during the course were recorded based on the following score: normal pancreas 0, edema 1, edema plus exudate 2, extent of necrosis <30% 3, necrosis <50% 4, necrosis >50% 5. Patients received either Placebo or 3 x 100µg or 3 x 200µg Octreotide subcutaneously for 7 days and they were followed for a total of 30 days. Results: A contrast-enhanced CT was performed in the Placebo group (n=103) in 90 pats after 96h since onset of symptoms, where 79 patients (88%) showed a score of _2. In 63 cases a follow-up CT was done with the documentation of an unchanged finding in 28 patients (44%), a detorioration in 22 pats (35%) (3 and 2 score points in 6, and 1 score point in 10 cases), an improvement in the CT findings was found in 13 patients (21%) (with 2 scorepoints in 4 and 1 score point in 9 cases). These figures were similar in both Octreotide groups receiving 3 x 100µg or 3 x 200µg Octreotide/day.

Conclusions: Neither contrast medium nor Octreotide in the human situation showed a negative influence on the clinical course of acute pancreatitis. Therefore, contrast-enhanced CT-scanning is not harmful and should still be used as the gold standard for the staging of this disease, especially for clinical trials.

Copyright 1996 - 1998, SSAT, Inc. Revised 29 June 1998.