Novosti
Khirurgii

 This journal is
indexed in Scopus
journal cover
android icon Android Applicaion

Year 2022 Vol. 30 No 3

REVIEWS

Y.S. VINNIK, O.V. TEPLYAKOVA, A.D. ERGULEEVA

RELEVANCE OF PREVENTION OF THE INFECTIOUS COMPLICATIONS IN ACUTE PANCREATITIS

Professor V.F. Voino-Yasenetsky Krasnoyarsk State Medical University
Krasnoyarsk, Russian Federation

The failed outcomes of infected necrotizing pancreatitis treatment make the prevention of infectious complications particularly relevance. Despite the objective benefits of non-surgical management in patients with sterile pancreatic necrosis, pharmacologic therapies facilities in the early period of the disease remain limited. Concordantly to available evidence the efficiency of fluid resuscitation, anticoagulants, antioxidants, epidural blockade, hyperbaric oxygen therapy, antisecretory agents, protease inhibitors, antibiotics, immunomodulators, enteral nutrition and minimally invasive surgical approaches to prevent infectious complications in predicted severe acute pancreatitis is considered in this review. Preventive strategies for septic complications of acute necrotizing pancreatitis such as intravenous fluid resuscitation, use of anticoagulants, epidural analgesia and early enteral feeding the evidence is strong. Advantages of enteral nutrition cannot be overemphasized from the standpoint of the trigger role of intestinal contents in the pathogenesis of pancreatogenic infection, as well as the level of evidence of relevant clinical studies.

Keywords: acute severe pancreatitis, infected necrotizing pancreatitis, early enteral nutrition, epidural blockade, antibiotics
p. 306-316 of the original issue
References
  1. Lubyansky VG, Zharikov AN, Arutyunyan GA, Nasonov VV, Bykov VM, Ustinov DN, Aliev AR. modern approaches to surgical treatment of pancreatic necrosis. Bulletin of Medical Science. 2017. ¹ 2. Ñ. 38-46. doi: 10.31684/2541-8475.2017.2(6).43-52 (In Russ.)
  2. Bensman VM, Savchenko YUP, Shcherba SN, Malyshko VV. Gnipel AS, Golikov IV. Surgical resolutions determining outcomes of infected pancreatic necrosis. Khirurgiia. Zhurn im NI Pirogova. 2018;(8):12-18. doi: 10.17116/hirurgia2018812(In Russ.)
  3. Leppäniemi A, Tolonen M, Tarasconi A, Segovia-Lohse H, Gamberini E, Kirkpatrick AW, Ball CG, Parry N, Sartelli M, Wolbrink D, van Goor H, Baiocchi G, Ansaloni L, Biffl W, Coccolini F, Di Saverio S, Kluger Y, Moore E, Catena F. 2019 WSES guidelines for the management of severe acute pancreatitis. World J Emerg Surg. 2019 Jun 13;14:27. doi: 10.1186/s13017-019-0247-0. eCollection 2019.
  4. Ning C, Huang G, Shen D, Bonsu AAFK, Ji L, Lin C, Cao X, Li J. Adverse clinical outcomes associated with multidrug-resistant organisms in patients with infected pancreatic necrosis. Pancreatology. 2019 Oct;19(7):935-40. doi: 10.1016/j.pan.2019.09.008
  5. Chen HZ, Ji L, Li L, Wang G, Bai XW, Cheng CD, Sun B. Early prediction of infected pancreatic necrosis secondary to necrotizing pancreatitis. Medicine (Baltimore). 2017 Jul;96(30):e7487. doi: 10.1097/MD.0000000000007487
  6. Zheng Z, Ding YX, Qu YX, Cao F, Li F. A narrative review of the mechanism of acute pancreatitis and recent advances in its clinical management. Am J Transl Res. 2021 Mar 15;13(3):833-52. eCollection 2021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8014344/
  7. Baron TH, DiMaio CJ, Wang AY, Morgan KA. American Gastroenterological Association Clinical Practice Update: Management of Pancreatic Necrosis. Gastroenterology. 2020 Jan;158(1):67-75.e1. doi: 10.1053/j.gastro.2019.07.064
  8. Moggia E, Koti R, Belgaumkar AP, Fazio F, Pereira SP, Davidson BR, Gurusamy KS. Pharmacological interventions for acute pancreatitis. Cochrane Database Syst Rev. 2017 Apr 21;4(4):CD011384. doi: 10.1002/14651858.CD011384.pub2
  9. Vlasov AP, Mitroshin AN, Nikol’skiy VI, Cuslov AV, Muratova TA. Basics of antioxidant therapy in acute pancreatitis (experimental study). Vestn Anesteziologii i Reanimatologii. 2016;13(3):14-18. doi: 10.21292/2078-5658-2016-13-3-14-18 (In Russ.)
  10. Vinnik IuS, Per’ianova OV, Iakimov SV, Anishina OV, Petrushko SI. Primenenie ozonirovannogo fiziologicheskogo rastvora v kompleksnom lechenii gnoinykh oslozhnenii ostrogo pankreatita. Annaly Khirurg Gepatologii. 2002;7(1):59-62. (In Russ.)
  11. Tozlu M, Kayar Y, Ince AT, Baysal B, Şentürk H. Low molecular weight heparin treatment of acute moderate and severe pancreatitis: A randomized, controlled,open-label study. Turk J Gastroenterol. 2019 Jan;30(1):81-87. doi: 10.5152/tjg.2018.18583
  12. Jeurnink SM, Nijs MM, Prins HA, Greving JP, Siersema PD. Antioxidants as a treatment for acute pancreatitis: A meta-analysis. Pancreatology. 2015 May-Jun;15(3):203-8. doi: 10.1016/j.pan.2015.03.009
  13. Vinnik IuS, Tepliakova OV. Znachenie intraabdominal’noi gipertenzii u bol’nykh s ostrym pankreatitom. Vestn Khirurgii im II Grekova. 2016;175(5):110-13. https://www.vestnik-grekova.ru/jour/article/view/358 (In Russ.)
  14. Jabaudon M, Belhadj-Tahar N, Rimmelé T, Joannes-Boyau O, Bulyez S, Lefrant JY, Malledant Y, Leone M, Abback PS, Tamion F, Dupont H, Lortat-Jacob B, Guerci P, Kerforne T, Cinotti R, Jacob L, Verdier P, Dugernier T, Pereira B, Constantin JM; Azurea Network. Thoracic Epidural Analgesia and Mortality in Acute Pancreatitis: A Multicenter Propensity Analysis. Crit Care Med. 2018 Mar;46(3):e198-e205. doi: 10.1097/CCM.0000000000002874
  15. Butkevich ATs, Istratov VG, Brovkin AE, Nalivaiskii AA, Riabkov MG, Klychnikova EV. Kompleksnaia otsenka tiazhesti i effektivnosti intensivnoi terapii pankreonekroza. Moskov Khirurg Zhurn. 2014;(3):28-32. (In Russ.) 16.Kolotushkin IA, Balnykov SI, Trohanov MJ, Polytov Syu.. Evaluation effect of octreotide on mortality pationts with necrotizing pancreatitis. Nauka Molodykh (Eruditio Juvenium). 2014;(4):88-94 (In Russ.)
  16. Dibirov MD. Domarev LV. Shitikov EA, Isayev AI,. KarsotiyaN GS. Principles «cliff» pancreatic necrosis in a first-aid hospital. Khirurgiia Zhurn im NI Pirogova. 2017;(1):73-77. doi: 10.17116/hirurgia2017173-77(In Russ.) 18.Sun C, Li Z, Shi Z, Li G. Current diagnosis and treatment of acute pancreatitis in China: a real-world, multicenter study. BMC Gastroenterol. 2021 May 8;21(1):210. doi: 10.1186/s12876-021-01799-1
  17. Firsova VG, Parshikov VV, Kukosh MV, Mukhin AS. Antibacterial and antifungal therapy for patients with acute pancreatitis at high risk of pancreatogenic sepsis (Review) Sovrem Tekhnologii v Meditsine. 2020;12(1):126-38. doi: 10.17691/stm2020.12.1.15 (In Russ.)
  18. Andriushchenko VP, Andriushchenko DV, Mahlovahyi VV. Clinical Evaluation of the Features of Current Pancreatic Infection as a Component of the Multidisciplinary Principle of Treatment Tactics in Acute Pancreatitis. Novosti Khirurgii. 2021;29(6):671-79. doi: 10.18484/2305-0047.2021.6.671 (In Russ.)
  19. Fomin AV, Okulich VK, Ovsianik DM. Antibiotic prophylaxis and therapy of infected pancreatic necrosis adjusted for gastric microbial indicators Àííàëû Õèðóðã Ãåïàòîëîãèè. 2014;19(3):99-105. (In Russ.)
  20. Alekseev S, Tarasenko A, Hevsky P, Dudko A, Alekseev V. Method of prevention of purulent-septic complications of acute destructive pancreatitis. Surgery. Eastern Europe. 2017;6(3):400-10. (In Russ.)
  21. Lim CL, Lee W, Liew YX, Tang SS, Chlebicki MP, Kwa AL. Role of antibiotic prophylaxis in necrotizing pancreatitis: a meta-analysis. J Gastrointest Surg. 2015 Mar;19(3):480-91. doi: 10.1007/s11605-014-2662-6
  22. Schwender BJ, Gordon SR, Gardner TB. Risk factors for the development of intra-abdominal fungal infections in acute pancreatitis. Pancreas. 2015 Jul;44(5):805-7. doi: 10.1097/MPA.0000000000000334
  23. Trikudanathan G, Munigala S. Impact of Clostridium difficile infection in patients hospitalized with acute pancreatitis- a population based cohort study. Pancreatology. 2017 Mar-Apr;17(2):201-202. doi: 10.1016/j.pan.2017.02.012
  24. Vinnik IuS, Miller SV, Karapetian GE, Sychev AG, Iakimov SV, Tepliakova OV. Drenirovanie v khirurgii. Krasnoiarsk, RF; 2007. 184 p. (In Russ.)
  25. Vlasov AP, Salahov EK, Shibitov VA,. Vlasov PA, Bolotskih VA. Integrated approach to correction enteral insufficiency in early postoperative period. Khirurgiia. Zhurn im. N. I. Pirogova. 2016;(5):52-58. doi: 10.17116/hirurgia2016552-58 (In Russ.)
  26. Khalidov OK, Fomin VS, Gudkov AN, Zayratyants GO, Dmitrienko GP, Svitina KA. Percutaneous resonance stimulation in complex correction of intraabdominal hypertension and dynamic intestinal obstruction in patients with severe acute pancreatitis. Annaly Khirurgicheskoy Gepatologii = Annals of HPB Surgery. 2018;23(3):23-30 doi: 10.16931/1995-5464.2018323-30. (In Russ.)
  27. Andriushchenko VP, Andriushchenko DV, Kunovskyi VV, Lysiuk YS. Efficiency of Nutritional Support in Surgical Treatment of Patients with Acute Pancreatitis. Novosti Khirurgii. 2019;27(5):515-21. doi: 10.18484/2305-0047.2019.5.515. (In Russ.)
  28. Wu P, Li L, Sun W. Efficacy comparisons of enteral nutrition and parenteral nutrition in patients with severe acute pancreatitis: a meta-analysis from randomized controlled trials. Biosci Rep. 2018 Nov 15;38(6):BSR20181515. doi: 10.1042/BSR20181515
  29. Li W, Liu J, Zhao S, Li J. Safety and efficacy of total parenteral nutrition versus total enteral nutrition for patients with severe acute pancreatitis: a meta-analysis. J Int Med Res. 2018 Sep;46(9):3948-58. doi: 10.1177/0300060518782070
  30. Qi D, Yu B, Huang J, Peng M. Meta-Analysis of Early Enteral Nutrition Provided Within 24 Hours of Admission on Clinical Outcomes in Acute Pancreatitis. JPEN J Parenter Enteral Nutr. 2018 Sep;42(7):1139-47. doi: 10.1002/jpen.1139
  31. Achkasov EE , Pugaev AV, Nabieva ZhG, Kalachev SV. Effect of different nutritional support on pancreatic secretion in acute pancreatitis. Khirurgiia. Zhurn im NI Pirogova. 2018;(1):14-20. doi: 10.17116/hirurgia2018114-20. (In Russ.)
  32. Singh N, Sharma B, Sharma M, Sachdev V, Bhardwaj P, Mani K, Joshi YK, Saraya A. Evaluation of early enteral feeding through nasogastric and nasojejunal tube in severe acute pancreatitis: a noninferiority randomized controlled trial. Pancreas. 2012 Jan;41(1):153-59. doi: 10.1097/MPA.0b013e318221c4a8
  33. Poropat G, Giljaca V, Hauser G, Štimac D. Enteral nutrition formulations for acute pancreatitis. Cochrane Database Syst Rev. 2015 Mar 23;(3):CD010605. doi: 10.1002/14651858.CD010605.pub2
  34. Lakananurak N, Gramlich L. Nutrition management in acute pancreatitis: Clinical practice consideration. World J Clin Cases. 2020 May 6;8(9):1561-73. doi: 10.12998/wjcc.v8.i9.1561
  35. Tian X, Pi YP, Liu XL, Chen H, Chen WQ. Supplemented Use of Pre-, Pro-, and Synbiotics in Severe Acute Pancreatitis: An Updated Systematic Review and Meta-Analysis of 13 Randomized Controlled Trials. Front Pharmacol. 2018 Jun 28;9:690. doi: 10.3389/fphar.2018.00690. eCollection 2018
  36. Ponomar SA, Boldin BD. Key intracellular mechanisms in the pathogenesis of acute pancreatitis. Ëå÷åá Äåëî. 2021;(1):106-12. doi: 10.24412/2071-5315-2021-12298 (In Russ.)
  37. Lin R, Chen F, Wen S, Teng T, Pan Y, Huang H. Interleukin-10 attenuates impairment of the blood-brain barrier in a severe acute pancreatitis rat model. J Inflamm (Lond). 2018 Feb 27;15:4. doi: 10.1186/s12950-018-0180-0
  38. Akinosoglou K, Gogos C. Immune-modulating therapy in acute pancreatitis: fact or fiction. World J Gastroenterol. 2014 Nov 7;20(41):15200-15. doi: 10.3748/wjg.v20.i41.15200
  39. Li J, Yang WJ, Huang LM, Tang CW. Immunomodulatory therapies for acute pancreatitis. World J Gastroenterol. 2014 Dec 7;20(45):16935-47. doi: 10.3748/wjg.v20.i45.16935
  40. Safarov SS. Immunokorrektsiia v lechenii ostrogo pankreatita [Elektronnyi resurs]. Novyi Den’ v Meditsine. 2020;(1):394-97. [data obrashcheniia: 2022 Ianv 27]. Available from: https://elibrary.ru/item.asp?id=43014786 (In Russ.)
  41. Munir F, Jamshed MB, Shahid N, Hussain HM, Muhammad SA, Mamun AA, Zhang Q. Advances in immunomodulatory therapy for severe acute pancreatitis. Immunol Lett. 2020 Jan;217:72-76. doi: 10.1016/j.imlet.2019.11.002
  42. Belorusets VN, Karpitskij AS, Golubeva NN. Morphological changes in the retroperitoneal fat tissue in the early phase of acute necrotizing pancreatitis. Novosti Khirurgii. 2018;26(1):34-41. doi: 10.18484/2305-0047.2018.1.34 (In Russ.)
  43. Grekova NM, Shisfamencev NB, Naimushina YV, Buhvalov AG. Acute pancreatitis: Modem concepts of surgical treatment. Novosti Khirurgii. 2020;28(2):197-206. doi: 10.18484/2305-0047.2020.2.197 (In Russ.)
  44. Galperin EI, Dyuzheva TG, Shefer AV, Kotovskiy AE, Semenenko IA, Mudryak DL. Early interventions for disconnected pancreatic duct syndrome in acute pancreatitis. Annaly Khirurgicheskoy Gepatologii = Annals of HPB Surgery. 2021;26(2):25-31. doi: 10.16931/1995-5464.2021-2-25-31 (In Russ.)
  45. Korolkov AYu, Smirnov AA, Popov DN, Saadylaeva MM, Nikitina TO., Bagnenko SF. Surgical treatment of acute biliary pancreatitis. Grekov’s Bulletin of Surgery. 2021;180(1):40-44. doi: 10.24884/0042-4625-2021-180-1-40-44 (In Russ.)
  46. Karjula H, Nordblad Schmidt P, Mäkelä J, Liisanantti JH, Ohtonen P, Saarela A. Prophylactic pancreatic duct stenting in severe acute necrotizing pancreatitis: a prospective randomized study. Endoscopy. 2019 Nov;51(11):1027-34. doi: 10.1055/a-0865-1960
  47. Van Wanrooij RLJ, van Hooft JE. Bridging the gap or paving the way for uninvited guests? Endoscopy. 2019;51(11):1015-16. doi: 10.1055/a-0901-749148.
  48. Malkov IS, Zainutdinov AM, Khamzin II, Makarov DV, Khalilov KhM, Gubaev RF. Improvement of acute destructive pancreatitis management. Pirogov Russian Journal of Surgery = Khirurgiya. Zurnatim. N.I. Pirogova. 2021;(4):34-38. doi: 10.17116/hirurgia202-104134 (In Russ.)
Address for correspondence:
660022, Russian Federation,
Krasnoyarsk, Partizan Zheleznyan st.,1,
Krasnoyarsk State Medical University
named after Professor V.F. Voyno-Yasenetsky,
tel. +7 (391) 220-19-09,
å-mail: teplyakova-olga@ya.ru
Teplyakova Olga V.
Information about the authors:
Vinnik Yurii S., MD, Professor, Head of the Department of General Surgery Named Professor M. I. Gulman, Professor V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russian Federation. https://orcid.org/0000-0002-8995-2862
Teplyakova Olga V., MD, Associate Professor, Professor of the Department of General Surgery Named Professor M. I. Gulman, Professor V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russian Federation.
https://orcid.org/0000-0003-0005-3316
Erguleeva Anna D., Resident of the Department of General Surgery Named Professor M. I. Gulman, Professor V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russian Federation.
https://orcid.org/0000-0002-7000-4467
Contacts | ©Vitebsk State Medical University, 2007-2023