A RANDOMISED CONTROL STUDY ON EFFECT OF OCTREOTIDEIN MANAGEMNT OF ACUTE PANCREATITIS WITH VARYINGSEVERITIES

Abstract

Background: Acute pancreatitis is an acute inflammatory process of the pancreas with variable involvement of other
regional tissues or organ systems. Theories on pathogenesis of acute pancreatitis suggest that autodigestion of the gland and
peripancreatic tissues by activated digestive enzymes is a key component. Octreotide is a potent inhibitor of pancreatic
secretion, but the benefits of octreotide in acute pancreatitis in humans is still inconclusive.
Aim: To study the effect of octreotide in acute pancreatitis with different severities.
Method: 284 patients were assigned into two groups randomly, the study group comprising of 138 patients received inj
octreotide 100 μg S.C. 8 hrly. The other aspects of the treatment protocol were similar in both groups. Severity of the
disease was evaluated initially according to Ranson criteria, APACHE II SCORING, CRP values & Balthazar grading.
Both the groups were observed prospectively and outcome of treatment was evaluated.
Results: The results were analysed after dividing both the study and control group into 5 groups each according-to
increased severities. The complication rate was 10% in group 1 and 28% in group 2 according to APACHE II among the
study group, whereas it was 23% and 46% in the conrol group respectively. The values in patients stratified according to
other criterias were also comparable. The results in cases of severe pancreatitis were poor, complication rates varying from
56% to 100% in the 3'd and 5th group according to Ranson criteria among the study group and 62% to 100% respectively
among the control group. Mortality of the study and control group also did not show any significant changes.
Conclusion: Inhibition of secretory function in the early course of the disease especially in mild and moderate cases of
pancreatitis has been shown to improve final outcome. As in case of acute pancreatitis it is very difficult to estimate the
severity and disease progress at the very onset, and as the majority of cases are mild to moderate in severity, it will be
beneficial to start with octreotide in any treatment protocol along with supportive resuscitative measures.