Colloids in acute pancreatitis: Microcirculatory advantage or inflammatory mirage

Vollständiger Abstract

Worum geht es in dieser Arbeit?

The quest for optimal fluid resuscitation in acute pancreatitis continues to challenge clinicians, balancing perfusion, inflammation, and safety. The recent randomized controlled trial published in World Journal of Gastrointestinal Surgery by Costea et al compared Dextran 40 Plus Ringer’s lactate solution with Ringer’s lactate solution alone in mild-to-moderate acute pancreatitis. While dextran-enhanced therapy significantly reduced C-reactive protein at 72 hours, it did not accelerate systemic inflammatory response syndrome resolution or improve clinical outcomes. This paradox rekindles debate on whether early biochemical improvement truly mirrors microcirculatory recovery. Physiologically, dextran may enhance capillary flow and protect the endothelial glycocalyx; however, these benefits appear transient and clinically neutral within current dosing limits. This editorial examines the evidence landscape, critiques methodological aspects, and situates the trial within the evolving paradigm of moderate, goal-directed fluid therapy. Ultimately, colloid supplementation may refine hemodynamic precision but remains an “inflammatory mirage” until larger, mechanistically informed trials confirm patient-centered benefit.