A randomized controlled trial of acute pancreatitis in Thanjavur medical college: an institutional experience
Keywords:Acute pancreatitis, Oral hydration, Antibiotics, Somatostatin analogues
Background: Acute pancreatitis is a prevalent gastrointestinal illness leading to hospitalizations in India, treated with rest, fluids, and analgesia. This study aimed to compare minimalistic and standard treatments for mild and moderate acute pancreatitis at Government Thanjavur Medical College. The outcome of patients with these conditions was assessed.
Methods: Conducted from July 2020 to July 2022, the randomized controlled trial enrolled acute pancreatitis patients, classified as mild, moderate, or severe based on the Revised Atlanta criteria. All mild and moderate cases were included and randomly assigned to two groups. Group one received early oral diet, hydration, and analgesia, omitting somatostatin analogues and antibiotics. Group two underwent comprehensive management. The outcomes of 130 patients, including those during the COVID-19 peak, were analyzed.
Results: No significant difference was found in the outcomes of patients with mild and moderate pancreatitis between the two treatments. All patients showed improvement during their hospital stay. Evaluation included hospital stay duration, sepsis development, and occurrence of local/systemic complications. Among them, three patients progressed to severe pancreatitis, with one fatality.
Conclusions: For mild and moderate pancreatitis, a minimalistic approach yielded comparable outcomes to active management. However, severe pancreatitis should follow existing guidelines, emphasizing prompt management of complications and systemic organ support.
Dong E, Chang JI, Verma D. Enhanced recovery in mild acute pancreatitis: a randomized controlled trial. Pancreas. 2019;48(2):176-81.
Baig SJ, Rahed A, Sen S. A prospective study of the aetiology, severity and outcome of acute pancreatitis in Eastern India. Trop Gastroenterol. 2008;29(1):20.
Sharma B, Srivastava S, Singh N. Role of probiotics on gut permeability and endotoxemia in patients with acute pancreatitis: a double-blind randomized controlled trial. J Clin Gastroenterol. 2011;45(5):442-8.
Khurram M, Bhar A, Bhattacharya D. Effect of octreotide on acute pancreatitis patients in kolkata, india: a randomized controlled trial. J Evol Med Dent Sci. 2016;5(42):2578-81.
Chowdhury AR, Chang P, Zhou S. Optimal initial diet in mild acute pancreatitis: A comprehensive meta-analysis of randomized control trials. Pancreatology. 2022;22(7):858-63.
Sateesh J, Bhardwaj P, Singh N, Saraya A. Effect of antioxidant therapy on hospital stayand complications in patients with early acutepancreatitis: A randomised controlled trial. Trop Gastroenterol. 2010;30(4):201-6.
Chauhan Y, Jindal N, Verma RK. A clinical profile and outcome of patients with acute pancreatitis: a prospective study in North India. Arch Int Surg. 2018;8(3):132.
Ramu R, Paul V, Devipriya S. Etiology, clinical profile and outcome of acute pancreatitis in a tertiary care teaching hospital in rural South India: a ten year retrospective study. Int Surg J. 2019;6(10):3794-9.
Rajkumar N, Karthikeyan VS, Ali SM. Clear liquid diet vs soft diet as the initial meal in patients with mild acute pancreatitis: a randomized interventional trial. Nutrition Clin Pract. 2013;28(3):365-70.
Chandana G, Surekha B, Kumar BP. Biochemical and Radiological Parameters in Acute Pancreatitis among Patients from a Rural Community of South India: A Retrospective and Correlational Study. J Datta Meghe Inst Med Sci Uni. 2022;17(2):275.
Peery AF, Crockett SD, Barritt AS. Burden of gastrointestinal, liver, and pancreatic diseases in the United States. Gastroenterology. 2015;149:1731-41.
Bakker OJ, van Brunschot S, van Santvoort HC. Early versus ondemand nasoenteric tube feeding in acute pancreatitis. N Engl J Med. 2014; 371:1983-93.
Wu LM, Pendharkar SA, Asrani VM. Effect of intravenous fluids and analgesia on dysmotility in patients with acute pancreatitis. Pancreas. 2017;46: 858-66.
Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after surgery: a review. JAMA Surg. 2017;152:292-8.
Coolsen MM, van Dam RM, van derWilt AA. Systematic review and meta-analysis of enhanced recovery after pancreatic surgery with particular emphasis on pancreaticoduodenectomies. World J Surg. 2013;37:1909-18.
Kagedan DJ, Ahmed M, Devitt KS. Enhanced recovery after pancreatic surgery: a systematic review of the evidence. HPB. 2015;17:11-6.
Buxbaum JL, Quezada M, Da B. Early aggressive hydration hastens clinical improvement in mild acute pancreatitis. Am J Gastroenterol. 2017;112:797-803.
Wu BU, Batech M, Quezada M. Dynamic measurement of disease activity in acute pancreatitis: the pancreatitis activity scoring system. Am J Gastroenterol. 2017;112:1144-52.
Grover AS, Mitchell PD, Manzi SF. Initial pain management in pediatric acute pancreatitis: opioid vs. non-opioid. J Pediatr Gastroenterol Nutr. 2018;66:295-8.
Basurto Ona X, Rigau Comas D, Urrútia G. Opioids for acute pancreatitis pain. Cochrane Database Syst Rev. 2013;26:179.
Peiró AM, Martínez J, Martínez E. Efficacy and tolerance of metamizole versus morphine for acute pancreatitis pain. Pancreatology. 2008;8:25-9.
Al-Omran M, AlBalawi ZH, Tashkandi MF. Enteral Versus Parenteral Nutrition for Acute Pancreatitis. Cochrane Syst Rev. 2010:CD002837.
Vaughn VM, Shuster D, Rogers MAM, et al. Early versus delayed feeding in patients with acute pancreatitis. Ann Intern Med. 2017;166:883-92.