Clinical Trials Logo

Clinical Trial Summary

Early diagnosis of secondary infection of necrotic tissue in severe acute pancreatitis is extremely important. The investigators evaluated whether the level of soluble TREM-1 (sTREM-1) in fine needle aspiration (FNA) fluid from patients who suspected infection is a good marker of secondary infection of necrotic tissue and an indicator of the proper treatment between drainage and necrosectomy.


Clinical Trial Description

The major cause of death, next to early organ failure, is secondary infection of pancreatic or peripancreatic necrotic tissue, leading to sepsis and multiple organ failure. The diagnosis and treatment of infected necrosis in SAP remain a major challenge for clinicians. The necrotic infection is defined when microorganisms are isolated from the samples of ultrasound or computed tomography (CT) guided fine needle aspiration (FNA). Unfortunately, a negative biopsy result can not completely rule out infection and the repeated aspirations may lead to bleeding or iatrogenic infection. Moreover, whatever the microbiologic diagnostic procedure chosen, further laboratory processing and delays of 24 to 48 hours are required for definitive quantitative microbial culture results. Meanwhile, clinicians often feel uncomfortable about the diagnosis and may administer unneeded antibiotics while awaiting laboratory results.

Secondary infection of necrotic tissue in SAP patients is virtually always an indication for intervention. The traditional approach is open necrosectomy to completely remove the infected necrotic tissue. This invasive approach is associated with high rates of complications (34 to 95%) and death (11 to 39%).As an alternative to open necrosectomy, less invasive techniques, including percutaneous drainage and endoscopic (transgastric) drainage, are increasingly being used.These steps may postpone or even obviate surgical necrosectomy with reducing complications and death.It remains uncertain which intervention is optimal in terms of clinical conditions of these patients and the severity of local infection.

Therefore, many biologic markers have been studied in an effort to improve the diagnostic rate and determine the the severity of necrosis infection but with disappointing results. The triggering receptor expressed on myeloid cells (TREM-1) is a member of the immunoglobulin superfamily whose expression on phagocytes is up-regulated by exposure to bacteria and fungi. TREM-1 mediates the acute inflammatory response to microbial products.[27] TREM-1 is also shed by the membrane of activated phagocytes and can be found in a soluble form in body fluids. We evaluated whether the lever of soluble TREM-1 (sTREM-1) in FNA fluid from patients who suspected infection is a good marker of secondary infection of necrotic tissue and an indicator of the proper treatment between drainage and necrosectomy. ;


Study Design

Observational Model: Case Control, Time Perspective: Prospective


Related Conditions & MeSH terms


NCT number NCT01193413
Study type Observational
Source Changhai Hospital
Contact
Status Completed
Phase N/A
Start date July 2008
Completion date November 2009

See also
  Status Clinical Trial Phase
Recruiting NCT03609944 - SpHincterotomy for Acute Recurrent Pancreatitis N/A
Not yet recruiting NCT04652271 - International Pancreatic Surgery Outcomes Study - PancreasGroup.Org
Completed NCT01441492 - Pancreas Resection With and Without Drains N/A
Recruiting NCT02196935 - Los Angeles Prospective GI Biliary and EUS Series
Completed NCT01476995 - Prognostic Indicators as Provided by the EPIC ClearView N/A
Completed NCT01545167 - The North American Pancreatitis Study N/A
Completed NCT04168801 - Early Oral Refeeding in Mild Acute Pancreatitis N/A
Recruiting NCT03334708 - A Study of Blood Based Biomarkers for Pancreas Adenocarcinoma
Completed NCT01824186 - Trial Comparing Pain in Single-incision Laparoscopic Cholecystectomy Versus Conventional Laparoscopic Cholecystectomy N/A
Terminated NCT00428025 - Diclofenac for the Prevention of Post-ERCP Pancreatitis in Higher Risk Patients Phase 4
Completed NCT00639314 - Trial on the Evaluation of Pylorus-ring in Pancreaticoduodenectomy N/A
Recruiting NCT00160836 - Biliary Tissue Sampling Using a Cytology Brush or the GIUM Catheter Phase 1
Completed NCT00121901 - Does Glyceryl Nitrate Prevent Post-Endoscopic Retrograde Cholangiopancreaticography (ERCP) Pancreatitis? Phase 3
Completed NCT00999232 - Assess the Effect of Erythromycin on the Rate of Success in Placement of a Self-propelled Feeding Tube Phase 4
Terminated NCT00419549 - Efficacy Study of Glyceryl-Trinitrate Patch and Parecoxib (Valdecoxib) for the Prevention of Pancreatitis After Endoscopic Retrograde Cholangiopancreatography (ERCP) Phase 2/Phase 3
Active, not recruiting NCT05095831 - EUS Shear Wave for Solid Pancreatic Lesions.
Completed NCT03601325 - Acute Pancreatitis: Study of Possible Etiologies and Risk Factors Affecting Outcome
Withdrawn NCT02465138 - A Randomized Controlled Trial of IV Ketorolac to Prevent Post-ERCP Pancreatitis Phase 4
Not yet recruiting NCT06133023 - WONDER-02 Trial: Plastic Stent vs. Lumen-apposing Metal Stent for Pancreatic Pseudocysts N/A
Recruiting NCT02971475 - ESWL Versus ESWL and Endoscopic Treatment N/A