Systematic review of peritoneal lavage and dialysis for patients with severe acute pancreatitis

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb Pub Date : 2025-04-01 DOI:10.1016/j.hpb.2025.01.011

Mikolaj R. Kowal , Varuni Bhatnagar , James Pine , Samir Pathak , Andrew Smith , Iestyn Shapey

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引用次数: 0

Abstract

Aims

Severe acute pancreatitis (SAP) remains a lethal condition with a rising incidence worldwide. Recent randomised trials suggest that peritoneal lavage and/or dialysis (PLD), when administered early in SAP, may be beneficial to improve patient outcomes. This study aimed to review this data systematically.

Methods

Studies featuring PLD for the treatment of SAP were searched systematically (2012 Atlanta classification to 2023). A traditional approach to reporting data was augmented by a narrative synthesis.

Results

210 articles were reviewed, of which six studies featuring 499 patients were included. The technical approach, duration and type of lavage varied in each study and no safety concerns were reported. In patients undergoing PLD, improvements in inflammatory markers and length of stay were seen in all studies. Where reported, fewer invasive procedures for peri-pancreatic fluid collections were required after PLD. Lower mortality was seen in cohorts receiving laparoscopic lavage alone and combined lavage and dialysis when compared with standard treatment. All studies were rated at moderate or high risk of bias.

Conclusions

PLD demonstrates potential as an early therapy to improve outcomes for patients with SAP. Further research is required to define intervention delivery, explore acceptability and investigate efficacy through a powered randomised controlled trial.

查看原文本刊更多论文

腹膜灌洗和透析治疗重症急性胰腺炎的系统评价。

目的：严重急性胰腺炎（SAP）仍然是世界范围内发病率上升的致命疾病。最近的随机试验表明，在SAP早期进行腹膜灌洗和/或透析（PLD）可能有利于改善患者的预后。本研究旨在系统地回顾这些数据。方法：系统检索以PLD治疗SAP为特征的研究（2012年亚特兰大分类至2023年）。传统的数据报告方法通过叙述综合得到了加强。结果：210篇文献被纳入，其中6项研究纳入499例患者。技术方法、持续时间和灌洗类型在每个研究中都有所不同，没有安全问题的报道。在接受PLD的患者中，所有研究都发现炎症标志物和住院时间的改善。据报道，在PLD后需要较少的侵入性胰周液收集手术。与标准治疗相比，单独接受腹腔镜灌洗和联合灌洗和透析的队列死亡率较低。所有研究均被评为中度或高度偏倚风险。结论：PLD显示了作为早期治疗改善SAP患者预后的潜力。需要进一步的研究来定义干预手段，探索可接受性，并通过一项有力的随机对照试验来调查疗效。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Hpb GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.60

自引率

3.40%

发文量

244

审稿时长

57 days

期刊介绍： HPB is an international forum for clinical, scientific and educational communication. Twelve issues a year bring the reader leading articles, expert reviews, original articles, images, editorials, and reader correspondence encompassing all aspects of benign and malignant hepatobiliary disease and its management. HPB features relevant aspects of clinical and translational research and practice. Specific areas of interest include HPB diseases encountered globally by clinical practitioners in this specialist field of gastrointestinal surgery. The journal addresses the challenges faced in the management of cancer involving the liver, biliary system and pancreas. While surgical oncology represents a large part of HPB practice, submission of manuscripts relating to liver and pancreas transplantation, the treatment of benign conditions such as acute and chronic pancreatitis, and those relating to hepatobiliary infection and inflammation are also welcomed. There will be a focus on developing a multidisciplinary approach to diagnosis and treatment with endoscopic and laparoscopic approaches, radiological interventions and surgical techniques being strongly represented. HPB welcomes submission of manuscripts in all these areas and in scientific focused research that has clear clinical relevance to HPB surgical practice. HPB aims to help its readers - surgeons, physicians, radiologists and basic scientists - to develop their knowledge and practice. HPB will be of interest to specialists involved in the management of hepatobiliary and pancreatic disease however will also inform those working in related fields. Abstracted and Indexed in: MEDLINE® EMBASE PubMed Science Citation Index Expanded Academic Search (EBSCO) HPB is owned by the International Hepato-Pancreato-Biliary Association (IHPBA) and is also the official Journal of the American Hepato-Pancreato-Biliary Association (AHPBA), the Asian-Pacific Hepato Pancreatic Biliary Association (A-PHPBA) and the European-African Hepato-Pancreatic Biliary Association (E-AHPBA).