Chymotrypsin Probe for Real-Time Visualization of Pancreatic Leak
Pancreatic fistula remains the most serious complication after digestive surgery. This is mainly because there are no techniques to identify pancreatic leak from the pancreatic stump during surgery. Nor have there been any techniques for rapid evaluation of protease activity in leaking fluid during surgery that can cause severe tissue damage. We have designed and developed a novel fluorescence probe (glutaryl phenylalanine hydroxymethyl rhodamine green) that is activated by chymotrypsin. The use of this novel probe is expected to result in a reduced incidence of pancreatic fistula and operative mortality after digestive surgery.
KeywordsPancreatic fistula Pancreatic leak Glutaryl phenylalanine hydroxymethyl rhodamine green Chymotrypsin
Financial Disclosure: The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in this manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, and royalties. No writing assistance was used in the production of this manuscript.
Funding/Support: This work was supported by grants from the Takeda Science Foundation, the Ministry of Education, Culture, Sports, Science, Technology of Japan, and the Ministry of Health, Labour, and Welfare of Japan, and Global Leader Program for Social Design and Management.
Fluorescence imaging of leaking pancreatic juice using the chymotrypsin probe. Fluorescence imaging clearly visualized leakage of pancreatic juice along a stapler line beginning 3 min after spraying chymotrypsin probe on the pancreatic stump (WMV 39,304 kb)
- 3.Ministry of Health, Labour and Welfare of Japan. Proceedings of Central Social Insurance Medical Council, 2008. Accessed 26 June 2009. http://www.mhlw.go.jp/shingi/2009/05/s0514-6.html
- 4.Yeo CJ, Cameron JL, Sohn TA, Lillemoe KD, Pitt HA, Talamini MA, Hruban RH, Ord SE, Sauter PK, Coleman J, Zahurak ML, Grochow LB, Abrams RA. Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes. Ann Surg. 1997;226:248–57.PubMedCentralCrossRefPubMedGoogle Scholar
- 6.Fuks D, Piessen G, Huet E, Tavernier M, Zerbib P, Michot F, Scotte M, Triboulet JP, Mariette C, Chiche L, Salame E, Segol P, Pruvot FR, Mauvais F, Roman H, Verhaeghe P, Regimbeau JM. Life-threatening postoperative pancreatic fistula (grade C) after pancreaticoduodenectomy: incidence, prognosis, and risk factors. Am J Surg. 2009;197:702–9.CrossRefPubMedGoogle Scholar
- 8.Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M, International study group on pancreatic fistula definition. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005;138:8–13.CrossRefPubMedGoogle Scholar
- 9.Kawai M, Tani M, Terasawa H, Ina S, Hirono S, Nishioka R, Miyazawa M, Uchiyama K, Yamaue H. Early removal of prophylactic drains reduces the risk of intra-abdominal infections in patients with pancreatic head resection: prospective study for 104 consecutive patients. Ann Surg. 2006;244:1–7.PubMedCentralCrossRefPubMedGoogle Scholar
- 10.Molinari E, Bassi C, Salvia R, Butturini G, Crippa S, Talamini G, Falconi M, Pederzoli P. Amylase value in drains after pancreatic resection as predictive factor of postoperative pancreatic fistula: results of a prospective study in 137 patients. Ann Surg. 2007;246:281–7.PubMedCentralCrossRefPubMedGoogle Scholar