Othman AAA. Colloids in acute pancreatitis: Microcirculatory advantage or inflammatory mirage. World J Gastrointest Surg 2026; 18(8): 115464 [DOI: 10.4240/wjgs.115464]
Corresponding Author of This Article
Amira Ahmed Abdelrahman Othman, MD, Department of Internal Medicine, Suez University, Cairo-Suez Road, Suez 43511, Egypt. amira.othman@med.suezuni.edu.eg
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
editorial
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World J Gastrointest Surg. Aug 27, 2026; 18(8): 115464 Published online Aug 27, 2026. doi: 10.4240/wjgs.115464
Colloids in acute pancreatitis: Microcirculatory advantage or inflammatory mirage
Amira Ahmed Abdelrahman Othman
Amira Ahmed Abdelrahman Othman, Department of Internal Medicine, Suez University, Suez 43511, Egypt
Author contributions: Othman AAA conceptualized the editorial theme, reviewed the relevant literature, and wrote the manuscript.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Corresponding author: Amira Ahmed Abdelrahman Othman, MD, Department of Internal Medicine, Suez University, Cairo-Suez Road, Suez 43511, Egypt. amira.othman@med.suezuni.edu.eg
Received: October 17, 2025 Revised: November 27, 2025 Accepted: January 4, 2026 Published online: August 27, 2026 Processing time: 303 Days and 12.3 Hours
Abstract
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.
Core Tip: Fluid resuscitation remains the cornerstone of acute pancreatitis care; however, the ideal composition remains unsettled. A recent randomized trial comparing Dextran 40 Plus Ringer’s lactate vs Ringer’s lactate alone demonstrated lower C-reactive protein but no difference in systemic inflammation or organ failure. This editorial explores why the apparent biochemical benefit may not translate into clinical improvement, highlighting the intricate interplay between microcirculation, endothelial integrity, and inflammatory signaling. The piece highlights how this study refines, not resolves, the colloid debate, underscoring the need for individualized, goal-directed hydration strategies guided by hemodynamic and perfusion markers rather than fixed formulas.
