Treatment outcome of selective digestive decontamination and enteral nutrition in patients with severe acute pancreatitis |
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Authors: | Sawa Hidehiro Ueda Takashi Takeyama Yoshifumi Yasuda Takeo Shinzeki Makoto Matsumura Naoki Nakajima Takahiro Matsumoto Ippei Fujita Tsunenori Ajiki Tetsuo Fujino Yasuhiro Kuroda Yoshikazu |
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Institution: | (1) Department of Gastroenterological Surgery, Kobe University Graduate School of Medical Sciences, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan;(2) Department of Surgery, Kinki University School of Medicine, Osaka-sayama, Japan |
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Abstract: | Background/Purpose Sepsis due to infected pancreatic necrosis is the most serious complication in the late phase of severe acute pancreatitis
(SAP). Bacterial translocation from the gut is thought to be the main cause of pancreatic infection. The possibility has recently
been reported that selective digestive decontamination (SDD) and enteral nutrition (EN) may alleviate the complications and
reduce the mortality rate in patients with SAP. We analyzed the treatment outcome of SDD and EN in patients with SAP.
Methods We divided 90 patients with SAP into three groups: SDD(−)EN(−),group A; SDD(+)EN(−), group B; and SDD(+)EN(+), group C. Clinical
outcome was analyzed retrospectively. The effect of SDD was compared in groups A and B, and the effect of EN was compared
in groups B and C.
Results The background of patients was not significantly different between the groups. SDD reduced the incidence of organ dysfunction
(from 70% to 59%) and the mortality rate (from 40% to 28%), but the differences were not significant. EN reduced the incidence
of infected pancreatic necrosis (from 31% to 24%) and the frequency of surgery for pancreas (from 28% to 18%), and further
reduced the mortality rate (from 28% for SDD to 16%), but the differences were not significant. The peripheral lymphocyte
count was significantly increased in patients with EN.
Conclusions SDD and EN did not significantly affect the treatment outcome in SAP. However, the results in this study raise the possibility
that SDD and EN may decrease the complications and reduce the mortality rate in SAP. The efficacy of SDD and EN for SAP should
be evaluated in a randomized controlled trial. |
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Keywords: | Severe acute pancreatitis Infection Enteral nutrition Selective digestive decontamination Parenteral nutrition |
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