Continuous regional arterial infusion of protease inhibitor and antibiotics in acute necrotizing pancreatitis

PURPOSE: This study was conducted to determine whether continuous regional arterial infusion (CRAI) of the protease inhibitor, nafamostat mesylate, in acute necrotizing pancreatitis, would reduce mortality, In addition, the effectiveness of CRAI of the antibiotic imipenem in combination with nafamostat was investigated for its effect in preventing secondary infection of the pancreatic necrotic tissue. PATIENTS AND METHODS: Fifty-three patients with acute necrotizing pancreatitis were divided into three groups: Group 1, 16 patients who were referred >8 days after disease onset, received intravenous nafamostat and antibiotics; Group II, 22 patients referred within 7 days, received nafamostat via CRAI, and antibiotics intravenously; Group III, 15 patients referred within 7 days, received both nafamostat and imipenem via CRAI. RESULTS: The mortality rates in group II (13.6%) and group III (6.7%) were significantly reduced, as compared with that in group I (43.8%), The incidence of infection of pancreatic necrosis in group III (0%) was significantly lower than those in group I (50%) and in group II (22.8%). CONCLUSION: CRAI of nafamostat and imipenem in acute necrotizing pancreatitis was effective in reducing mortality and preventing the development of pancreatic infection.