New strategy for acute necrotizing pancreatitis: Continuous Regional Arterial Infusion (CRAI) therapy

Mikami Y, Takeda K, Omura N, Abe H, Fukuyama S, 
Motoi F, Egawa S, Sunamura M, Matsuno S

Abstract

Acute pancreatitis is an autodigestive disease, of which protease inhibition has been the focus of experimental and clinical research. Different from Europe and the United States, protease inhibitors are often applied in the treatment of acute pancreatitis in Japan. However, in clinical settings, the effect of protease inhibitors on acute pancreatitis is still controversial. Continuous Regional Arterial Infusion (CRAI) of protease inhibitors and antibiotics therapy were developed in Japan and it has been demonstrated that CRAI therapy has beneficial effects on severe acute necrotizing pancreatitis. In the Japanese clinical guidelines for the treatment of acute pancreatitis, published in 2003, CRAI therapy is still classified as a special therapy. However, a  Randomized Controlled Trial for CRAI therapy has started and CRAI therapy is expected to become a new standard therapy for severe acute pancreatitis. CRAI therapy is aimed at preventing the progression of pancreatic inflammation and pancreatic infection. CRAI therapy can decrease the mortality rate and the frequency of pancreatic infection in severe acute pancreatitis, but it should be started as soon as possible after the onset of acute pancreatitis.

Key words: 	acute pancreatitis, Continuous Regional Arterial Infusion (CRAI) therapy, protease inhibitor, nafamostat mesilate, contrast enhanced CT, angiography.

Abbreviations: 	CRAI – Continuous Regional Arterial Infusion; RCT – Randomized Controlled Trial; CEA – celiac artery; SMA – supramesenteric artery; ICU – intensive care unit.