Costea NC, Vesa S, Toma M, Pojoga C, Seicean A. Fluid therapy strategies in acute pancreatitis: Randomized controlled trial comparing dextran and Ringer’s lactate. World J Gastrointest Surg 2025; 17(11): 109869 [DOI: 10.4240/wjgs.v17.i11.109869]
Corresponding Author of This Article
Andrada Seicean, PhD, Professor, Department of Gastroenterology, “Prof. Dr. Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Iuliu Hațieganu University of Medicine and Pharmacy, No. 19-21 Strada Croitorilor, Cluj-Napoca 400162, Cluj, Romania. andradaseicean@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Randomized Controlled Trial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Nov 27, 2025; 17(11): 109869 Published online Nov 27, 2025. doi: 10.4240/wjgs.v17.i11.109869
Fluid therapy strategies in acute pancreatitis: Randomized controlled trial comparing dextran and Ringer’s lactate
Nicolae Cristian Costea, Stefan Vesa, Mariana Toma, Cristina Pojoga, Andrada Seicean
Nicolae Cristian Costea, Department of Gastroenterology, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca 400162, Cluj, Romania
Nicolae Cristian Costea, Mariana Toma, Department of Gastroenterology, Satu Mare County Hospital, Satu Mare 440192, Romania
Stefan Vesa, Department of Pharmacology, Toxicology and Clinical Pharmacology, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca 400162, Cluj, Romania
Cristina Pojoga, Andrada Seicean, Department of Gastroenterology, “Prof. Dr. Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca 400162, Cluj, Romania
Cristina Pojoga, Department of Clinical Psychology and Psychotherapy, International Institute for Advanced Study of Psychotherapy and Applied Mental Health, Babes-Bolyai University, Cluj-Napoca 400162, Cluj, Romania
Author contributions: Costea NC contributed to the methodology design and project supervision; Costea NC, Vesa S, and Seicean A contributed to the formal analysis; Costea NC, Pojoga C, and Seicean A contributed to the manuscript writing including reviewing and editing for important intellectual content; Costea NC and Seicean A contributed to the study conceptualization; Vesa S contributed to statistical analysis; Toma M and Seicean A contributed to the data curation; Toma M contributed to writing of the original draft; Seicean A contributed to project administration and supervision. All authors read and approved the final manuscript.
Institutional review board statement: This study was approved by the Ethics Committee of the Satu Mare County Hospital (Approval No. 27/11.10.2021).
Informed consent statement: Participation in the study was voluntary, and expressed written informed consent was obtained prior to inclusion.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Data sharing statement: Access to the data set from this study is available from the corresponding author upon reasonable request and approval.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Andrada Seicean, PhD, Professor, Department of Gastroenterology, “Prof. Dr. Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Iuliu Hațieganu University of Medicine and Pharmacy, No. 19-21 Strada Croitorilor, Cluj-Napoca 400162, Cluj, Romania. andradaseicean@gmail.com
Received: May 28, 2025 Revised: June 21, 2025 Accepted: October 9, 2025 Published online: November 27, 2025 Processing time: 181 Days and 20.4 Hours
Abstract
BACKGROUND
Acute pancreatitis (AP) is a frequent gastrointestinal emergency characterized by inflammation. It has the potential to progress to organ failure. Fluid therapy plays a critical role in early AP management, mitigating hypovolemia-induced ischemia and systemic inflammatory response syndrome (SIRS).
AIM
To evaluate dextran 40 + Ringer’s lactate solution (RLS) vs RLS alone for fluid therapy in mild to moderate AP.
METHODS
We conducted a single-center, single-blind, randomized controlled trial involving 108 patients with mild to moderate AP. Participants were randomized to receive either dextran 40 + RLS (1:3 ratio) or RLS alone. All patients underwent standardized, goal-directed fluid therapy and were monitored for clinical response, inflammatory markers, and complications. The primary outcomes were reduction in C-reactive protein (CRP) and resolution of SIRS at 72 hours. Secondary outcomes included organ failure, intensive care unit admission, mortality, and length of hospital stay.
RESULTS
The dextran 40 + RLS group demonstrated significantly lower CRP levels. No differences were observed in SIRS changes, fluid overload, refractory status mortality, local complications, or organ failure rates. Hospitalization tended to be shorter in the dextran 40 + RLS group (5 days vs 6 days) although not to a statistically significant level (P = 0.1). Adverse events were mild and comparable in both groups.
CONCLUSION
Dextran 40 + RLS improved the early CRP response in patients with AP without added complications. Although medium-term outcomes were similar, early benefits support its use in initial management.
Core Tip: This randomized controlled trial investigated the effects of fluid resuscitation in patients with mild to moderate acute pancreatitis. The combination therapy of dextran 40 and Ringer’s lactate solution significantly improved early inflammatory markers and accelerated systemic inflammatory response syndrome resolution without increasing complication rates compared with Ringer’s lactate solution alone. Medium-term outcomes were comparable between groups. These findings support the potential benefit of early colloid-crystalloid fluid strategies in acute pancreatitis management and highlight the need for larger, multicenter studies to confirm long-term efficacy and safety.
