Clinical Efficacy of Enteral Saline Solution When Used as Part of Combined Treatment for Various Forms of Acute Pancreatitis

The article presents the results of a retrospective study of the effectiveness of intestinal lavage with enteral saline solution for the treatment of dynamic intestinal obstruction in acute forms of pancreatitis and pancreonecrosis. The objective of this study is to improve treatment results in patients with intestinal paresis with various forms of acute pancreatitis with the use of intestinal lavage with enteral saline solution.

Materials and methods. The study included 81 patients, 56 (69.1 %) males and 25 (30.9 %) females, the age averaging at 59.3 ± 13.4 years. These patients were hospitalized at different time intervals counting from the onset of the disorder, ranging from 24 hours to 7 days. Patients were divided in two groups depending on hospitalisation prior to the first procedure of intestinal lavage providing there was no counterindications.

Results and discussion. Prokinetic effect of intestinal lavage in patients with gastrostasis and dynamic bowel obstruction help improve the quality of conservative treatment (up to 78.3 % in 1^st group and 37.1 % in 2^nd group); avoid open surgical procedures (up to 6.5 % in 1^st group, up to 37.1 % in 2^nd group), perform minimally invasive procedures to drain confined lesions (15.2 % of patients in 1^st group, 42.9 % in 2^nd group); eliminate manifestations of gastrostasis within 3 days following IL in both groups. The reduction/elimination of dynamic intestinal obstruction within 24 hours following IL (up to 73.8 % in 1^st group, up to 97.1 % in 2^nd group) made it possible to start early enteral nutrition within 48 hours (73.9 % in 1^st group, up to 42.8 % in 2^nd group).

Conclusions. Early use of intestinal lavage in the complex therapy of acute forms of pancreatitis is safe and effective. It reduces the number of purulent-septic complications, prevents the development of multiple organ failure, reduces the overall mortality, prepares the intestine for early enteral nutrition.

1. Kubyshkin V.A., Zatevakhin I.I., Bagnenko S.F., Blagovestnov D.A., Vishnevskiy V.A., Galperin E.I., et al. National clinical guidelines for acute pancreatitis: tactics of diagnosis and treatment. Moscow; 2019. 38 p. (In Russ.).

2. Petrov M.S., Yadav D. Global epidemiology and holistic prevention of pancreatitis. Nat Rev Gastroenterol Hepatol. 2019;16(3):175–84. DOI: 10.1038/s41575-018-0087-5

3. Pagliari D., Rinninella E., Cianci R., Attili F., Franza L., Luciano R., et al. Early oral vs parenteral nutrition in acute pancreatitis: a retrospective analysis of clinical outcomes and hospital costs from a tertiary care referral center. Intern Emerg Med. 2019. Oct 16. DOI: 10.1007/s11739-019-02210-4

4. Ramanathan M., Aadam A.A. Nutrition management in acute pancreatitis. Nutr Clin Pract. 2019;34(Suppl. 1):S7–12. DOI: 10.1002/ncp.10386

5. Evseev M.A. Nutritional support for patients in the surgical clinic. Surgeon practice. 2015;(3):5–21 (In Russ.).

6. Shirjaev V.S., Gul’muradova N.T., Musihin L.V., Shvetskij F.M., Hosrovjan A.M. Combined low-intensity laser therapy and plasma depletion during the complex treatment of patients with pancreatitis. Wounds and wound infections. The prof. B.M. Kostyuchenok journal. 2016;3(3):32–7 (In Russ.). DOI: 10.17650/2408-9613-2016-3-3-32-37

7. Vakhrushev Ya.M., Lyapina M.V. Enteral failure and metabolic syndrome: Common neurohormonal mechanisms of development, possibilities of their rational therapy. Terapevticheskiy arkhiv. 2017;89(10):95–101 (In Russ.). DOI: 10.17116/terarkh2017891095-101

8. Takha K.D., Fedoseev A.V., Muraviev S.Y., Budarev V.N. Enteral insufficiency syndrome and its manifestations in acute pancreatitis patients. Perm Medical Journal. 2015;32(5):12–7 (In Russ.). DOI: 10.17816/pmj32512-17

9. Dibirov M.D., Isaev A.I., Jadjiev A.B., Ashimova A.I., Ataev T. Role of correction of the syndrome of intestinal failure and abdominal hypertension in the prevention of infection of pancreatic necrosis. Pirogov Russian Journal of Surgery. 2016;(8):67–72 (In Russ.). DOI: 10.17116/hirurgia2016867-72

10. Paulino J., Ramos G., Veloso Gomes F. Together we stand, divided we fall: a multidisciplinary approach in complicated acute pancreatitis. Clin Med. 2019;8(10):E1607. DOI: 10.3390/jcm8101607

11. Hartmann J., Werge M., Schmidt P.N., Hansen E.F., Pedersen U.G., Kristiansen K.T., et al. Modified Marshall Score predicts mortality in patients with walled-off pancreatic necrosis treated in an intensive care unit. Pancreas. 2019;48(9):e68–70. DOI: 10.1097/MPA.0000000000001409

12. Alsamarrai A., Das S.L., Windsor J.A., Petrov M.S. Factors that affect risk for pancreatic disease in the general population: a systematic review and meta-analysis of prospective cohort studies. Clin Gastroenterol Hepatol. 2014;12(10):1635–44. DOI: 10.1016/j.cgh.2014.01.038

13. Afghani E., Pandol S.J., Shimosegawa T., Sutton R., Wu B.U., Vege S.S., et al. Acute pancreatitis-progress and challenges: a report on an International symposium. Pancreas. 2015;44(8):1195–210. DOI: 10.1097/MPA.0000000000000500

14. Zerem E. Treatment of severe acute pancreatitis and its complications. World J Gastroenterol. 2014;20(38):13879–92. DOI: 10.3748/wjg.v20.i38.13879

15. Arutla M., Raghunath M., Deepika G., Jakkampudi A., Murthy H.V.V., Rao G.V., et al. Efficacy of enteral glutamine supplementation in patients with severe and predicted severe acute pancreatitis — A randomized controlled trial. Indian J Gastroenterol. 2019;38(4):338–47. DOI: 10.1007/s12664-019-00962-7

16. Elke G., van Zanten A.R., Lemieux M., McCall M., Jeejeebhoy K.N., Kott M., et al. Enteral versus parenteral nutrition in critically ill patients: an updated systematic review and meta-analysis of randomized controlled trials. Crit Care. 2016;20(1):117. DOI: 10.1186/s13054-016-1298-1

17. Schäfer C. Acute pancreatitis — diagnosis and treatment. MMW Fortschr Med. 2019;161(19):53–5. DOI: 10.1007/s15006-019-1063-x

18. Stigliano S., Sternby H., de Madaria E., Capurso G., Petrov M.S. Early management of acute pancreatitis: A review of the best evidence. Dig Liver Dis. 2017;49(6):585–94. DOI: 10.1016/j.dld.2017.01.168

19. Taha H.D., Fedoseev V.A., Murav’ev S.Yu., Budarev V.N. The syndrome of enteral insufficiency at patients with acute pancreatitis. RUDN journal of medicine. 2016;(4):112–7 (In Russ.).

20. Zvyagin A.A., Demidova V.S., Smirnov G.V. Biomarkers during intensive care for sepsis. Wounds and wound infections. The prof. B.M. Kostyuchenok journal. 2019;6(1):34–8 (In Russ.). DOI: 10.25199/2408-9613-2018-6-1-34-38