Influence of contrast medium and octreotide on course and outcome of severe acute pancreatitis

Background/aim: In experimental acute pancreatitis, a negative effect of bo th contrast medium and octreotide on the progress of pancreatic necrosis ha s been described. In the randomised controlled trial using octreotide in ac ute pancreatitis this effect was analysed. Patients and methods: Between 11/93 and 4/96 a total of 302 patients from 3 2 centers with moderate to severe acute pancreatitis were included (198 mal e, 104 female, mean age 50 years, range 18-93 years). CT findings at the ti me of inclusion to the study and the worst findings during hospitalisation were recorded based on the following score: normal pancreas 0 score points, edema 1, edema plus exudation 2, necrosis less than or equal to 30% 3, nec rosis >30-less than or equal to 50% 4, necrosis >50% 5. Patients received e ither placebo or 3 x 100 mu g or 3 x 200 mu g octreotide for 7 days and the y were followed for a total of 30 days. Results: A contrast-enhanced CT-scan was performed in the placebo group (n = 103) in 90 patients within 96 hours after onset of symptoms. Out of these patients, 79 patients (88%) were considered to have greater than or equal to 2 score points corresponding findings of severe acute pancreatitis. In 6 3 cases, a follow-up CT was done and 28 patients (44%) showed no change of the findings, a deterioration was found in 22 patients (35%), (3 and 2 scor e points in 6, one score point in 10 patients). An improvement in the CT fi ndings has been revealed in 13 patients (21%), (2 score points in 4, 1 scor e point in 9 cases). These figures were similar in both octreotide groups r eceiving 3 x 100 mu g and 3 x 200 mu g per day. Conclusion: Neither contrast medium nor octreotide in the human situation s howed a negative influence on the clinical course and outcome of acute panc reatitis. Therefore, contrast enhanced CT-scanning is not harmful and shoul d still considered as "gold standard" for the staging of this disease, espe cially in clinical trials.