Adding another first and this time ‘first in the world’ to the credit of PGI, the Department of Surgical Gastroenterology published a path-breaking study which has established the role of Streptokinase in the management of the dreaded disease of severe acute pancreatitis.
Detailing about the study, Dr Rajesh Gupta, Professor and head, Department of Surgical Gastroenterology, PGI, stated, “Streptokinase has been used since early 1960s for dissolution of intra-vascular thrombosis in pulmonary thromboembolism, myocardial infarction and deep vein thrombosis. The Department of Surgical Gastroenterology in collaboration with the Department of Medical Gastroenterology started off-label use of Streptokinase in 2013. The idea to use Streptokinase in patients of severe acute pancreatitis was conceptualised after we observed its successful use in chest collections by pulmonologists.”
Dr Gupta added, “We first conducted experimental work in 2013 to look at the effect of Streptokinase on pancreatic necrosis removed at the time of surgery and results were heartening. This encouraged us to use Streptokinase in two patients who were critical and not fit for surgery. We observed that addition of Streptokinase in irrigation fluid in abdominal drain led to gradual improvement in their clinical condition and both the patients recovered without need of surgery. We published this work in a top journal of pancreatic disease, Pancreatotology, in 2014.”
After this initial success, the department planned the first study in 2015 and subsequently did three more studies, including two MCh thesis in surgical gastroenterology in collaboration with Medical Gastroenterology and Radiology. The department combined data from four studies and published results in one of the top surgical journals, Surgery.
Attributing the success to the commitment and perseverance of the team comprising Prof Surinder Rana, Prof Mandeep Kang, Dr Ujjwal Gorsi, Prof Ritambra Nada and all senior and junior residents involved in the study, Dr Gupta threw light on the results as he said, “Results by our study have clearly shown that there was a significant decrease in the need of surgery with use of Streptokinase and there was no increase in complications with its use which was a major apprehension. Ours is the first large study involving more than 100 patients where Streptokinase has been proven efficacious in management of severe pancreatitis with infected necrosis. We have observed that results of Streptokinase were better with higher doses.”
Dr Gupta added that they have recently completed another study where they have compared use of Streptokinase with another agent, i.e. hydrogen peroxide, and found encouraging results with Streptokinase. This study is at present under consideration of another prominent journal. “Now we are planning a bigger study involving various surgical and medical gastroenterology departments in different parts of the country. It is the first time in the world that Streptokinase has been found to be a useful adjunct in management of severe acute pancreatitis. It is vital to emphasise that department of Surgical and Medical Gastroenterology are top departments in the country in thus field with a lot of research happening to reduce the complications and deaths in this dreaded disease, ” concluded Dr Gupta.