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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?...161

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.