A Randomised, Prospective Study Comparing Two Contrast Media in ERCP

Wj, Cunliffe; Cobden, I; Mi, Lavelle; Lendrum, R; Np, Tait; Cw, Venables

doi:10.1055/s-2007-1013018

Cited by 31 publications

(8 citation statements)

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“…Ten prospective, randomised studies have been performed in attempts to compare the frequency of pancreatic enzyme level elevation, clinical pancreatitis and the quality of pancreatograms with use of low-and high-osmolar agents [17][18][19][20][21][22][23][24][25][26]. Six of these studies [17][18][19][20][21][22] suggested that the low-osmolar media were more safe, whereas four [23][24][25][26] showed no difference between the media.…”

Section: Discussionmentioning

confidence: 99%

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Iopentol (Imagopaque® 250) compared with diatrizoate (Urografin® 219) in endoscopic retrograde cholangio-pancreatography (ERCP) A clinical trial assessing safety (adverse events and S-pancreatic iso-amylase) and diagnostic information (VAS)

et al. 1997

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The efficacy and safety of the non-ionic contrast medium iopentol, 250 mg I/ml (Imagopaque, Nycomed Imaging AS, Oslo, Norway) were evaluated and compared to those of the ionic contrast medium diatrizoate 219 mg I/ml (Urografin, Schering AG, Berlin, Germany). The trial was carried out as a randomized, double-blind comparative two-group study. One hundred and sixteen patients completed the study: 59 received iopentol and 57 received diatrizoate, the contrast medium used according to routine hospital procedure for ERCP. Demographic data and details of the ERCP procedure were comparable for the two contrast medium groups. Safety was assessed by monitoring serum pancreatic iso-amylase and by recording adverse events. Efficacy was evaluated through assessment of the diagnostic information and the quality of radiographs. Twenty-one of the patients receiving iopentol and 27 of the patients receiving diatrizoate reported adverse events during the ERCP procedure. Pain was the kind of procedure-related event most frequently reported. Three patients experienced serious adverse events with a fatal outcome 2, 10 and 12 days after the ERCP procedure, respectively. The principal investigator concluded for all three serious adverse events that any causal relationship with the contrast medium injected was unlikely. A mean change in serum pancreatic iso-amylase after contrast medium injection was noted in both contrast medium groups. However, statistical analysis did not show any significant difference between mean changes for the two groups. The efficacy results, both in terms of diagnostic information and quality of radiographic visualisation, were comparable for the two contrast media. In conclusion, the study did not show any statistically significant differences between the two contrast media as regards safety or efficacy in ERCP.

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Section: Discussionmentioning

confidence: 99%

“…Six of these studies [17][18][19][20][21][22] suggested that the low-osmolar media were more safe, whereas four [23][24][25][26] showed no difference between the media. Inconclusive results may have been due to sample sizes being too small, since the minimal sample size adequate to compare the two agents consists of 84 subjects [27].…”

Section: Discussionmentioning

confidence: 99%

Iopentol (Imagopaque® 250) compared with diatrizoate (Urografin® 219) in endoscopic retrograde cholangio-pancreatography (ERCP) A clinical trial assessing safety (adverse events and S-pancreatic iso-amylase) and diagnostic information (VAS)

et al. 1997

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“…Pancreatitis occurs more frequently in those patients with pancreatic-type SOD, rather than those who have it performed for problems associated with chronic pancreatitis [57][58][59][60][61] . Thorough data concerning the use of pancreatic stents in the prevention pancreatitis following a pull-type sphincterotomy is somewhat lacking [62][63][64][65][66] .…”

Section: Complications Of Epsmentioning

confidence: 99%

Pancreatic sphincterotomy: Technique, indications, and complications

Buscaglia

Kalloo²

2007

WJG

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Pancreatic sphincterotomy serves as the cornerstone of endoscopic therapy of the pancreas. Historically, its indications have been less well-defined than those of endoscopic biliary sphincterotomy, yet it plays a definite and useful role in diseases such as chronic pancreatitis and pancreatic-type sphincter of Oddi dysfunction. In the appropriate setting, it may be used as a single therapeutic maneuver, or in conjunction with other endoscopic techniques such as pancreatic stone extraction or stent placement. The current standard of practice utilizes two different methods of performing pancreatic sphincterotomy: a pull-type sphincterotome technique without prior stent placement, and a needleknife sphincterotome technique over an existing stent. The complications associated with pancreatic sphincterotomy are many, although acute pancreatitis appears to be the most common and the most serious of the early complications. As such, it continues to be reserved for those endoscopists who perform a relatively high-volume of therapeutic pancreaticobiliary endoscopic retrograde cholangio-pancreatography.

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“…The results of several placebo-controlled, randomized trials using prophylactic agents such as calcium channel blockers [15,16] , topical lidocaine [17] , nonionic contrast media [18][19][20][21][22][23] , corticosteroids [24][25][26][27][28][29] , low-dose allopurinol [27] , N-acetylcysteine [30] , selenium [31] , natural ␤ -carotene [32] , PAF (platelet-activating factor) inhibitors [33] , and heparin derivatives [34,35] have all been rather disappointing. Pretreatment with high-dose, orally administered allopurinol decreased the frequency of post-ERCP pancreatitis in a recent study [36] .…”

Section: Pharmacological Prevention Of Post-ercp Pancreatitismentioning

confidence: 99%

Pharmacological Prevention and Treatment of Acute Pancreatitis: Where Are We Now?

Lankisch

Lerch²

2006

Dig Dis

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Acute pancreatitis is a disease of increasing prevalence, unchanged mortality over many decades, and limited treatment strategies. Progress has been made in developing therapies that reduce the rate of endoscopic retrograde cholangiopancreatography (ERCP)-associated pancreatitis and in preventing infected pancreatic necrosis with intravenous carbapenems. Attempts at reducing pancreatic enzyme output or inhibiting the activity of digestive enzyme proteases have not yielded encouraging results – nor have anti-inflammatory strategies for the treatment of acute pancreatitis been found to be effective so far. Future therapeutic options that are presently being developed or under investigation attempt to restore pancreatic secretory function, interfere with inflammatory pathways in a more effective manner, or inhibit digestive enzyme proteases more selectively.

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A Randomised, Prospective Study Comparing Two Contrast Media in ERCP

Cited by 31 publications

References 0 publications

Iopentol (Imagopaque® 250) compared with diatrizoate (Urografin® 219) in endoscopic retrograde cholangio-pancreatography (ERCP) A clinical trial assessing safety (adverse events and S-pancreatic iso-amylase) and diagnostic information (VAS)

Iopentol (Imagopaque® 250) compared with diatrizoate (Urografin® 219) in endoscopic retrograde cholangio-pancreatography (ERCP) A clinical trial assessing safety (adverse events and S-pancreatic iso-amylase) and diagnostic information (VAS)

Pancreatic sphincterotomy: Technique, indications, and complications

Pharmacological Prevention and Treatment of Acute Pancreatitis: Where Are We Now?

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