ENDOSCOPIC CARBON DIOXIDE INSUFFLATION INTO THE PANCREATIC DUCT: IS IT POSSIBLE TO MANAGE THE ACUTE PANCREATITIS BY DECREASING LOCAL pH TO SUPPRESS ENZYMATIC SELF-DIGESTION?
DOI: 10.22138/2500-0918-2021-18-2-161-185
D.S. Trenin¹, A.V. Kul’minskiy², I.D. Trenin³, M.A. Kul’minskiy³
¹ State Budget Professional Educational Institution «Sverdlovsk Regional Medical College», Novoural’sk Branch, Novoural’sk, Russian Federation;
² Sverdlovsk Regional Clinical Hospital No. 1, Yekaterinburg, Russian Federation;
³ Federal State Budget Educational Institution of Higher Education «Ural State Medical University», Yekaterinburg, Russian Federation.
Abstract. Background: the main clinical symptoms of the acute pancreatitis (AP) used to be explained by a local and a systemic action of activated pancreatic enzymes. Methods. To evaluate a conceptual possibility of the management of AP, the self-digestive enzyme suppression by the local рН lowering via the endoscopic carbon dioxide insufflation into the pancreatic duct has been simulated numerically. For the main patterns of a duct system structure, the СО2 diffusion, рН distributions, kinetic constants of trypsin and lipase have been calculated. Results. The СО2 diffusion zone volume-averaged рН has been revealed to vary within 7,16-7,44. For such a decrease, the lipase activity been assessed as nearly intact, but the trypsin proteolysis — as suppressed per 28-46%, and per 12-24% of its initial level for a low and a high substrate concentration, respectively. The diagnostic insufflation of 10 ml of CO2 within the time of 10 s been estimated to expand the near duct diffusion front for only 0,84-1,04 mm, which is not enough for embracing the entire wall of the main pancreatic duct to provide its anti-trypsin protection. To get it, the insufflation should be prolonged up to ~1 min, providing ~2,3 mm diffusion zone depth. Subsequent distribution of CO2 within the gland volume has been shown to furnish the volume-averaged рН value for ~ 7,69-7,95, and to inhibit the proteolysis per 4-15% for a low, and per 0-5% for a high substrate concentration. As predicted, the diffusion zone spread up to the gland walls would require the prolongation up to ~ 11-73 min depending on a specific surface area of the duct system. Conclusion. A possibility of the pancreatic enzyme suppression by endoscopic CO2 insufflation into the pancreatic duct for AP management has been numerically assessed and conceptually confirmed.
Keywords: carbon dioxide, endoscopic insufflation, acute pancreatitis, self-digestion, рН, numerical simulation
There is no conflict of interest.
Contact details of the corresponding author:
Dmitriy S. Trenin
mdtrenin@bk.ru
Received 08.02.2021
For citation:
Trenin D.S., Kul’minskiy A.V., Trenin I.D., Kul’minskiy M.A. Endoscopic Carbon Dioxide Insufflation into the Pancreatic Duct: is it Possible to Manage the Acute Pancreatitis by Decreasing Local pH to Suppress Enzymatic Self-Digestion? [Online] Vestn. Ural. Med. Akad. Nauki. = Journal of Ural Medical Academic Science. 2021, Vol. 18, no. 2, pp. 161–185. DOI: 10.22138/2500-0918-2021-18-2-161-185 (In Russ)
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Authors
Dmitriy S. Trenin
MD, PhD, teacher
State Budget Professional Educational Institution «Sverdlovsk Regional Medical College» (SBPEI «SRMC») of the Ministry of Health of Sverdlovsk Region, Novoural’sk Branch
7 Furmanova str., Novoural’sk, 624130, Russian Federation
mdtrenin@bk.ru
Andrey V. Kul’minskiy
Endoscopy doctor
Sverdlovsk Regional Clinical Hospital № 1
185 Volgogradskaya str., Yekaterinburg, 620102, Russian Federation
office@okb1.ru
Ivan D. Trenin
Student
Federal State Budget Educational Institution of Higher Education «Ural State Medical University» of the Ministry of Health of the Russian Federation (FSBEI HE «USMU» MH RF)
3 Repina str., Yekaterinburg, 620028, Russian Federation
treninjohn@gmail.com
Mikhail A. Kul’minskiy
Student
Federal State Budget Educational Institution of Higher Education «Ural State Medical University» of the Ministry of Health of the Russian Federation (FSBEI HE «USMU» MH RF)
3 Repina str., Yekaterinburg, 620028, Russian Federation
mikhail.kulminsky@gmail.com
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)