Effect of lanreotide 30 MG on prevention of pain relapse after oral refeeding in patients with necrotizing acute pancreatitis (AP): A phase II prospective multicentric study

Abstract

Background: Pain relapse after oral refeeding occurs in 21% of the patients with acute pancreatitis, and in 35% of those with CT Balthazar’s score 6D [Gut 1997;40:262]. Somatostatin analogues may decrease the pain relapse rate by inhibiting exocrine pancreatic secretion. Aims, Patients and Methods: To assess the frequency of pain relapse in patients with acute necrotizing pancreatitis after treatment with one intramuscular injection of lanreotide 30 mg on the day before refeeding. The refeeding procedure was standardized and progressive. Results: 23 patients were included in 4 centres. Acute pancreatitis was alcoholic (n = 11), biliary (n = 7), other (n = 5). Twelve patients had 63 Ranson’s criteria. Balthazar’s score (1985) was D or E in 7 and 16 patients, respectively. Median duration of pain and of interruption of oral feeding were 11 (3–23) and 16 (5–34) days, respectively. Median hospital stay was 22 (9–41) days. Only 1 patient (4.3 %) had pain occurring 3 days after refeeding. Conclusion: Pain relapse occurred in 4.3% of patients pretreated with the somatostatin analogue lanreotide, and this figure is lower than the expected 35% rate which was previously reported without preventive treatment. This suggests that one intramuscular injection of lanreotide 30 mg on the day before refeeding could decrease pain relapse in patients with acute necrotizing pancreatitis, but has to be confirmed in a phase III study. Copyright © 2004 S. Karger AG, Basel and IAP In patients with a severe episode of acute pancreatitis, the refeeding period is critical due to restimulation of pancreatic secretion and patients may have relapsing pain or recurrence of acute pancreatitis. Only one study has ascertained the frequency of pain relapse during oral refeeding in patients with acute pancreatitis [1]. This study, which was a multivariate multicentre prospective study, revealed that risk factors for pain relapse were Balthazar’s CT scores [2] 6D and serum lipase concentration 13 times the upper limit of normal range on the day before refeeding [1]. Pain relapse required oral feeding cessation and doubled total hospitalisation stay [1]. Somatostatin and its analogues are known to potently inhibit pancreatic exocrine secretion [3, 4]. An injection of the long-acting somatostatin analogue lanreotide (So-