SEARCHNARRATIVE_REVIEWgastroenterology, internal medicine

narrative_review·gastroenterology, internal medicine, endocrinology, obstetrics and gynecology, critical care·PMC10546782

The role of apheresis and insulin therapy in hypertriglyceridemic acute pancreatitis—a concise review

BMC Gastroenterology · 1 author, 2 centres

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TL;DR

Controlled studies show TPE lowers triglycerides only moderately faster than conservative treatment within 24 hours, with no definitive data on improved clinical outcomes.

Full summary

858 CHARS

This narrative review evaluates the evidence for TPE and insulin in HTG-AP. HTG accounts for about 2–10% of AP cases generally and up to 28–48% during pregnancy. Controlled studies consistently show TPE achieves approximately 70% triglyceride reduction versus approximately 50% with conservative treatment within 24 hours. This moderate difference is unlikely to be clinically significant in most patients. Limited non-randomized data show no improvement in clinical outcomes with TPE. Neither TPE nor insulin has definitive randomized evidence of efficacy on clinical endpoints. The author suggests TPE may be considered in severe HTG-AP when triglyceride decline with conservative treatment is insufficient, and in HTG-AP during pregnancy. Results from the ongoing ELEPHANT randomized trial are expected to clarify the respective roles of these treatments.

STUDY TYPE

narrative_review

SPECIALTY

gastroenterology

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AI pipeline

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100% · A

ORIGINAL PAPER

PMC10546782

The role of apheresis and insulin therapy in hypertriglyceridemic acute pancreatitis—a concise review

BMC Gastroenterology

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ABSTRACT

Severe hypertriglyceridemia (HTG) is the third most common cause of acute pancreatitis (AP) and is involved in its pathogenesis. Chylomicrons increase blood viscosity and induce ischemia, while free fatty acids induce inflammation and distant organ damage. Conservative treatment options include fasting and insulin; limited evidence shows their comparable efficacy. Plasma exchange might provide more rapid lowering of triglycerides and amelioration of systemic effects of severe AP. Available data from controlled studies show only moderately faster lowering of triglycerides with apheresis (about 70% vs. 50% with conservative treatment within 24 h) and limited data from non-randomized studies show no improvement in clinical outcomes. New evidence is expected soon from ongoing large randomized trials. Until then, insulin may be used in mild HTG-AP and plasma exchange should be considered only in severe HTG-AP, especially if the decline of triglycerides with conservative treatment is slow, and in HTG-AP during pregnancy.

CITATION EXPORT

Jakob Gubensek. The role of apheresis and insulin therapy in hypertriglyceridemic acute pancreatitis—a concise review. BMC Gastroenterology. (2023). https://doi.org/10.1186/s12876-023-02957-3

AUTHORS

1 · 2 CENTRES

Jakob Gubensek

1grid.29524.380000 0004 0571 7705Department of Nephrology, University Medical Center Ljubljana, Zaloska cesta 7, 1000 Ljubljana, Slovenia
2https://ror.org/05njb9z20grid.8954.00000 0001 0721 6013Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia