Z Gastroenterol 2006; 44 - A125
DOI: 10.1055/s-2006-943491

Selective bowel decontamination in acute necrotising pancreatitis

Z Szántó 1, I Pulay 2, T Dinka 1
  • 1Dept. of General- Vascular and Thoracic Surgery County Hospital Szolnok
  • 21st Department of Surgery, Semmelweis University, Budapest

The high mortality (10–30%) of acute necrotising pancreatitis is bound up with (endogenous) infection of the necrotic tissues. Changing this connection is the aim of conservative treatment. Together with intensive care and enteral feeding, we used selective bowel decontamination (SBD) which can prevent endogenous infections by reducing the number of potentially pathogen microbes (aerobe bacteria, fungi) in the oropharynx and gastro-intestinal tract, saving anaerobe bacteria. We considered its influence on mortality, frequency of septic complications, number of invasive treatments needed and on hospitalization time.

In our prospective, comparative, randomized study we included 20 patients so far, half of them received SBD. Inclusion criteria were the serious general condition (APACHE II. 10–25) and CT findings (Balthazar C, D, and E.) As systemic prevention group 1. (APACHE II.=16) received imipenem/cilastatin, group 2. (APACHE II.=15.3) received ceftazidime and metronidazol. Group 2 SBD gel (to gingiva) and suspension (into nasojejunal tube) included amphotericin-B, norfloxacin and vancomycin. We proceeded with decontamination for 2–4 weeks depending on the course of pancreatitis.

In our experience SBD was technically simple. Our patients had neither side effects, nor an increase in microbial resistance. The decontamination suspension and gel must be manufactured individually in the institutions, and can be stored for a short period, which complicates the method. Though our number of patients does not give a definitive basis to statistical analysis, we consider that SBD group had fewer septic complications, shorter hospitalization (43 vs. 52 days), lower mortality rate (20% vs. 40%) and number of invasive treatments per patient (1.3 vs. 2.3)

Early results of our trial suggest that selective decontamination assists preventing serious septic complications, and helps interventional radiology to treat necrosis successfully in increasing number of patients.