Efficacy of Enteral Saline Solution by Measuring I-FABP in Patients With Severe Acute Pancreatitis: A Non-Randomized Clinical Study



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Abstract

BACKGROUND: Intestinal microcirculatory injuries in patients with severe acute pancreatitis result in neuroendocrine dysregulation, intestinal epithelial cell dysfunction, and impaired intestinal motility.

AIM: This study aimed to assess the efficacy of enteral corrective therapy of intestinal failure in patients with severe acute pancreatitis using an enteral saline solution.

METHODS: A multicenter, non-randomized clinical study included 146 patients with severe acute pancreatitis (112 [76.7%] males and 34 [23.3%] females, mean age: 50.8 [SD ± 13.7] years). The patients were divided into two groups. The control group included 52 patients (35 [67.3%] males and 17 [32.7%] females, mean age: 50.9 [SD ± 15.0] years) who received standard of care. The treatment group included 94 patients (69 [73.4%] males and 25 [26.6%] females, mean age: 46.6 [SD ± 9.5] years) who additionally received enteral therapy using an enteral saline solution. The solution’s composition was identical to that of chyme from the first part of the small intestine in apparently healthy individuals. Its acidic environment (pH 5.0–5.8) has a bacteriostatic effect and inhibits the growth of opportunistic and pathogenic microorganisms. Enteral therapy was provided via a nasointestinal tube, which was placed along the endoscopic instrument channel and attached to the ligament of Treitz. The solution (1500 mL) was administered at a rate of 6–10 mL/min with intra-abdominal pressure monitoring, which did not exceed 16 mmHg. The Mann–Whitney U test was used for intergroup comparisons. Differences were considered significant at p < 0.05.

RESULTS: The treatment group showed a decrease in intestinal injury marker (I-FABP) levels the day after starting enteral therapy. On days 2 and 7, there was a significant decrease in intestinal fatty acid binding protein (I-FABP) levels to 1.52 ng/mL (p = 0.049) and 1.42 ng/mL (p = 0.01), respectively. These values were comparable to the median I-FABP level in the control group (1.40 ng/mL), which was used as a reference. On day 2, the threshold value was comparable to the reference (p = 0.049), with a significant decrease on day 7 (p = 0.01).

CONCLUSION: The findings confirm the efficacy of the enteral saline solution in patients with severe acute pancreatitis.

About the authors

Vladimir V. Kulabukhov

N.V. Sklifosovsky Research Institute for Emergency Medicine

Email: kulabuchovvv@sklif.mos.ru
ORCID iD: 0000-0003-1769-7038
SPIN-code: 8256-1630

MD, Cand. Sci. (Medicine), leading research associate, Depart. Of emergency surgery, endoscopy and intensive therapy

Russian Federation, Moscow

Vladimir V. Kiselev

N.V. Sklifosovsky Research Institute for Emergency Medicine

Author for correspondence.
Email: kiselevvv@sklif.mos.ru
ORCID iD: 0000-0002-0170-7775
SPIN-code: 2668-8690

MD, Cand. Sci. (Medicine), leading research associate, Depart. of Emergency Surgery, Endoscopy and Intensive Contemporary Therapy

Russian Federation, Moscow

Mariya S. Zhigalova

N.V. Sklifosovsky Research Institute for Emergency Medicine

Email: ZhigalovaMS@sklif.mos.ru
ORCID iD: 0000-0003-4520-1124
SPIN-code: 7034-4851

MD, Cand. Sci. (Medicine), senior research associate, Depart. of Emergency Surgery, Endoscopy and Intensive Contemporary Therapy

Russian Federation, Moscow

Nataliya V. Borovkova

N.V. Sklifosovsky Research Institute for Emergency Medicine

Email: BorovkovaNV@sklif.mos.ru
ORCID iD: 0000-0002-8897-7523
SPIN-code: 9339-2800

MD, Dr. Sci. (Medicine), Head, Scientific Depart. of Biotechnology and Transfusiology

Russian Federation, Moscow

Petr A. Yartsev

N.V. Sklifosovsky Research Institute for Emergency Medicine

Email: peter-yartsev@yandex.ru
ORCID iD: 0000-0003-1270-5414
SPIN-code: 4044-9661

MD, Dr. Sci. (Medicine), professor, head, Depart. of Emergency Surgery, Endoscopy and Intensive Contemporary Therapy

Russian Federation, Moscow

Alexandr I. Kostin

N.V. Sklifosovsky Research Institute for Emergency Medicine

Email: KostinAI@sklif.mos.ru
ORCID iD: 0000-0001-7542-851X
SPIN-code: 7119-8871

MD, Cand. Sci. (Medicine), head, depart. of clinical, production transfusiology and gravitational blood surgery

Russian Federation, Moscow

Nataliya P. Shen

Regional Clinical Hospital No. 1

Email: nataliashen@rambler.ru
ORCID iD: 0000-0002-3256-0374
SPIN-code: 2963-7338

MD, Dr. Sci. (Medicine), professor, head, Depart. of Anesthesiology and Resuscitation, head, anesthetic and resimation service, chief anesthetist-resuscitator

Russian Federation, Tyumen

Ionas S. Simutis

North-West District Scientific and Clinical Center named after L.G. Sokolov

Email: simutis@mail.ru
ORCID iD: 0000-0002-2537-0142
SPIN-code: 3619-2048

MD, Dr. Sci. (Medicine), head, intensive care unit and intensive therapy

Russian Federation, Saint Petersburg

Sergey N. Perekhodov

Russian University of Medicine

Email: persenmd@mail.ru
ORCID iD: 0000-0001-7166-0290
SPIN-code: 8770-6877

MD, Dr. Sci. (Medicine), professor, corresponding member of the Russian Academy of Sciences, head, depart. of hospital and military field surgery

Russian Federation, Moscow

Dmitry A. Zelenin

Russian University of Medicine

Email: d_zelenin@inbox.ru
ORCID iD: 0000-0001-6622-4734
SPIN-code: 9418-3070

MD, Dr. Sci. (Medicine), assistant professor, Depart. of Hospital and Military Field Surgery

Russian Federation, Moscow

Anton Y. Sitnikov

Medical and sanitary unit «Neftyanik»

Email: sitnikovayu@mail.ru
ORCID iD: 0009-0006-9918-3506

doctor anesthesiologist-resuscitator of the highest qualification category, head, depart. of anesthesiology-resimation

Russian Federation, Tyumen

Elena A. Lebedeva

Rostov State Medical University

Email: okulus@yandex.ru
ORCID iD: 0000-0001-8375-7743
SPIN-code: 1639-7843

MD, Dr. Sci. (Medicine), Assistant Professor, Head, Depart. of Anesthesiology and Resuscitation

Russian Federation, Rostov-on-Don

Oleg O. Balyshev

Rostov State Medical University

Email: obalyshev@bk.ru
ORCID iD: 0000-0002-6525-8294
SPIN-code: 2888-9689

Assistant Lecturer, Depart. of Anesthesiology and Resuscitation

Russian Federation, Rostov-on-Don

Ruslan A. Zefirov

Republican Clinical Hospital

Email: abdominalsurgery@mail.ru
ORCID iD: 0000-0003-3599-3834

MD, Cand. Sci. (Medicine), Deputy Chief physician for medical work, senior teacher, Depart. of surgical diseases of postgraduate education

Russian Federation, Kazan

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