The results of severe acute pancreatitis treatment with continuous regional arterial infusion of protease inhibitor and antibiotic: a randomized controlled study

Pancreas. 2010 Aug;39(6):863-7. doi: 10.1097/MPA.0b013e3181d37239.


Objectives: A randomized controlled trial was conducted to clarify whether continuous regional arterial infusion (CRAI) of protease inhibitor and antibiotic could reduce mortality rate of severe acute pancreatitis (SAP).

Methods: Seventy-eight patients with SAP were included in the study. Thirty-nine patients were treated with CRAI, 31 patients completed the study; and another group of 39 patients was treated without CRAI therapy. Groups were well matched in clinical characteristics. The CRAI patients were treated continuously with nafamostat mesylate 240 mg/d and imipenem 1 g/d for 5 days via one of the arteries perfusing the pancreas. Later, imipenem was given intravenously (0.5 g every 8 hours) for 9 days. The non-CRAI patients received imipenem (0.5 g every 8 hours) intravenously for 14 days. Statistical analysis of the intention-to-treat (ITT) group was performed.

Results: Lack of septic complications was observed in 23 patients with CRAI therapy and 20 non-CRAI patients (not significant). The additional antibiotics were applied in 8 of CRAI patients and in 18 non-CRAI (ITT, P = 0.02). Mortality rate was 5.1% in CRAI and 23.1% in non-CRAI group (ITT, P = 0.02). Urgent surgical intervention was necessary in 10.3% CRAI patients and in 33.3% non-CRAI (ITT, P = 0.01).

Conclusions: The results show that CRAI of protease inhibitor and antibiotic is effective in preventing complications and in reducing mortality rate in SAP.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Acute Disease
  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / therapeutic use
  • Benzamidines
  • Drug Administration Schedule
  • Drug Therapy, Combination
  • Female
  • Guanidines / administration & dosage
  • Guanidines / therapeutic use*
  • Humans
  • Imipenem / administration & dosage
  • Imipenem / therapeutic use*
  • Infusions, Intra-Arterial
  • Infusions, Intravenous
  • Male
  • Middle Aged
  • Pancreatitis / drug therapy*
  • Pancreatitis / mortality
  • Pancreatitis / pathology
  • Protease Inhibitors / administration & dosage
  • Protease Inhibitors / therapeutic use
  • Severity of Illness Index
  • Survival Rate
  • Treatment Outcome


  • Anti-Bacterial Agents
  • Benzamidines
  • Guanidines
  • Protease Inhibitors
  • Imipenem
  • nafamostat