Inhibitors of Pancreatic Secretion and Antiproteases in Acute Pancreatitis and Pancreatic Surgery

  • Ezio Caratozzolo
  • Marco Massani
  • Nicolò Bassi
Part of the Updates in Surgery book series (UPDATESSURG)


Acute pancreatitis is a common and potentially life-threatening condition that requires a multidisciplinary team for diagnosis and correct treatment [1]. Although it is one of the most studied conditions in the history of medicine, acute pancreatitis still remains a demanding and dreadful disease. It may be considered as self-digestion of the pancreas, and progress in recent years in our understanding of the pathophysiology has led to some improvement in the diagnosis and outcome for patients suffering from the severe form of the disease [2, 3, 4]. Usually the pancreatic enzymes, in the form of proenzymes, are transported from pancreatic ducts in the duodenum, where they are activated. In acute pancreatitis there is early activation of intracellular zymogens with a complex phenomenon that leads to inflammation and tissue damage [4]. The severe course of the disease is characterized by a systemic inflammatory response that can induce multiorgan failure. Comprehension of this early activation of proenzymes represents the basis from which to understand the disease and develop its treatment [5, 6]. In the assessment of therapy we believe it is essential to distinguish between the acute phase, treatment of the causal factor, and the prevention of pancreatic fistula after surgical resection. This last aspect will form the final part of this chapter.


Acute Pancreatitis Chronic Pancreatitis Pancreatic Fistula Severe Acute Pancreatitis Pancreatic Secretion 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Cirenei A, Hollender LF (1997) Le pancreatiti acute oggi. Piccin Nuova Libraria, Padua, pp 15–64Google Scholar
  2. 2.
    Nagar AB, Gorlick FS (2004) Acute pancreatitis. Curr Opinion Gastr 20:439–443CrossRefGoogle Scholar
  3. 3.
    Balthazar EJ (2002) Acute pancreatitis: assessment of severity with clinical and CT evaluation. Radiology 223:602–613CrossRefGoogle Scholar
  4. 4.
    Wang ZE, Pan CE, Lu Y et al (2003) The role of inflammatory mediators in severe acute pancreatitis and regulation of glucocorticoids. Hepatobiliary Pancreat Dis Int 2:458–462PubMedGoogle Scholar
  5. 5.
    Hentic, Levy P, Hammel P et al (2003) Are the causes similar for benign and severe forms of acute pancreatitis? Gastroenterol Clin Biol 27:403–406PubMedGoogle Scholar
  6. 6.
    Ghen X, Wu H, Hang X et al (2002) The alteration of inflammatory cytokine during acute pancreatitis. Hua Xi Yi Ke Da Xue Xue Bao 33:238-240Google Scholar
  7. 7.
    Gruppo Italiano AISP (2001) La pancreatite acuta in Italia: studio osservazionale su 1005 pazienti. Press ServiceGoogle Scholar
  8. 8.
    Gruppo Italiano AISP (2004) La pancreatite acuta: storia naturale e terapia medica ragionata In: AISP (ed) Attualità in pancreatologia. AISP, pp 3–12Google Scholar
  9. 9.
    Haraldsen P, Sun SW, Börjesson A et al (2003) Multimodal management: of value in fulminant acute pancreatitis? Pancreatology 3:14–25CrossRefPubMedGoogle Scholar
  10. 10.
    Kitagawa M, Hayakawa T (2007) Antiproteases in the treatment of acute pancreatitis. JOP 8(Suppl):518–525PubMedGoogle Scholar
  11. 11.
    Takeda K (2007) Antiproteases in the treatment of acute necrotizing pancreatitis: continuous regional arterial infusion. JOP 8(Suppl):526–532PubMedGoogle Scholar
  12. 12.
    Pezzilli R, Fantini L, Morsilli-Labate AM (2006) New approaches for the treatment of acute pancreatitis. JOP 7:79–91PubMedGoogle Scholar
  13. 13.
    Kausch W (1912) Das Carcinoma der Papilla duodeni und seine radikale Entfernung. Beitr Klin Chir 78:439–451Google Scholar
  14. 14.
    Whipple AO (1942) Present-day surgery of the pancreas. N Engl J Med 226:515–518CrossRefGoogle Scholar
  15. 15.
    Stojadinovic A, Brooks A, Hoos A et al (2003) An evidence-based approach to the surgical management of resectable pancreatic adenocarcinoma. J Am Coll Surg 196:954–964CrossRefPubMedGoogle Scholar
  16. 16.
    Li-Ling J, Irving M (2001) Somatostatin and octreotide in the prevention of postoperative pancreatic complications and the treatment of enterocutaneous pancreatic fistulas: a systematic review of randomized controlled trials. Br J Surg 88:190–199CrossRefPubMedGoogle Scholar
  17. 17.
    Büchler M, Friess H, Klempa I et al (1992) Role of octreotide in the prevention of postoperative complications following pancreatic resection. Am J Surg 163:125–130CrossRefPubMedGoogle Scholar
  18. 18.
    Büchler M, Friess H (1993) Prevention of postoperative complications following pancreatic surgery. Digestion 54(Suppl):41–46PubMedGoogle Scholar
  19. 19.
    Klempa L, Schwedes U, Usadel KH (1979) Verhütung von postoperativen pankreatischen Komplikationen nach Duodenopankreatekomie durch Somatostatin. Chirurgie 50:427–431Google Scholar
  20. 20.
    Lambert SWJ, Van Der Lely AJ, De Herder WW et al (1996) Octreotide. N Engl J Med 334:246–254CrossRefGoogle Scholar
  21. 21.
    Yeo CJ, Cameron JL, Maher MM et al (1995) A prospective randomized trial of pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy. Ann Surg 222:580–588PubMedGoogle Scholar

Copyright information

© Springer-Verlag Italia 2009

Authors and Affiliations

  • Ezio Caratozzolo
    • 1
  • Marco Massani
    • 1
  • Nicolò Bassi
    • 1
  1. 1.4th Division of Surgery, Regional Reference Center of Hepato-Biliary-Pancreatic SurgeryRegional Hospital Ca’ FoncelloTrevisoItaly

Personalised recommendations