Chinese expert consensus on perioperative medications for endoscopic retrograde cholangiopancreatography (ERCP)

Bai, Yu; Li, De Feng; Wang, Shu Ling; Zhao, Sheng; Ren, Shu; Zhang, Shu Tian

doi:10.1111/1751-2980.12699

Cited by 7 publications

(5 citation statements)

References 99 publications

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“…Somatostatin is a promising pharmacological agent because of its positive biological impacts, such as exocrine pancreatic secretion inhibition, reduction of the sphincter of Oddi contractions, modulation of the cytokine cascade, and protection against possible pancreatic acinar 14 . The efficiency of somatostatin against PEP is recognized by scholars globally and is written into the guideline 15 …”

Section: Discussionmentioning

confidence: 99%

“…14 The efficiency of somatostatin against PEP is recognized by scholars globally and is written into the guideline. 15 This investigation adopted a factorial design and grouped patients into placebo, indomethacin, somatostatin, and indomethacin + somatostatin groups. The data revealed that VAS levels of IL-6, TNF-α, and IL-8 substantially increased in all 4 groups, sequentially from 6 to 24 h post operation in comparison with pretreatment, suggesting that ERCP-induced inflammatory reaction can be alleviated by somatostatin and indomethacin.…”

Section: Discussionmentioning

confidence: 99%

“… 14 The efficiency of somatostatin against PEP is recognized by scholars globally and is written into the guideline. 15 …”

Section: Discussionmentioning

confidence: 99%

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Effects of Somatostatin and Indomethacin Mono or Combination Therapy on High-risk Hyperamylasemia and Post-pancreatitis Endoscopic Retrograde Cholangiopancreatography Patients: A Randomized Study

Wu,

Xiao,

Wang

et al. 2023

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Background: Endoscopic retrograde cholangiopancreatography (ERCP) is a minimally invasive technique widely used to diagnose and treat pancreatic and biliary diseases; however, it is linked with imminent hyperamylasemia and post-ERCP pancreatitis (PEP). Somatostatin and indomethacin are the classic recommended drugs used for PEP prevention. Objective: To elucidate the effects of somatostatin and indomethacin mono or in combination to prevent hyperamylasemia and PEP in high-risk individuals. Methods: Altogether 1458 patients who underwent ERCP in our hospital from January 2016 to May 2022 were included in this investigation and categorized into 4 groups based on the treatment regimen: placebo, indomethacin, somatostatin, and indomethacin + somatostatin. The pre operation and post operation (at 6, 12, and 24 h) hospitalization cost, length of stay, the occurrence of hyperamylasemia and PEP, levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), IL-8, and VAS pain score were determined in the 4 groups. In all the groups, VAS and IL-6, TNF-α, and IL-8 levels substantially increased in the pretreatment and decreased sequentially from 6 to 24 h post operation. The individuals in the indomethacin revealed substantially reduced hyperamylasemia, VAS, and levels of IL-6, TNF-α, and IL-8, 6 h post operation, whereas the hospitalization fee, length of stay, PEP incidence, VAS, levels of IL-6, TNF-α, and IL-8, 12 and 24 h post operation were not statistically important in comparison with the individuals who received placebo therapy. The somatostatin and the indomethacin + somatostatin groups indicated markedly alleviated hospitalization fee, length of stay, the occurrence of hyperamylasemia and PEP, VAS, and the levels of IL-6, TNF-α, and IL-8 at 6, 12, and 24 h post operation compared with the placebo cohort. Furthermore, compared with the indomethacin group, the above-determined factors notably reduced at 6, 12, and 24 h post operation in somatostatin and indomethacin + somatostatin groups. It was also observed that the indomethacin + somatostatin group has substantially decreased the occurrence of hyperamylasemia, VAS score, and levels of IL-6, TNF-α, and IL-8, 6 hours post operation, while at 12 and 24 h post operation, the hospitalization fee, length of stay and incidence of PEP, VAS, levels of IL-6, TNF-α, and IL-8 were not statistically important compared with the somatostatin group. It is also worth noting that the side effects of both drugs are rare and mild. Results: For high-risk PEP patients, indomethacin and somatostatin can efficiently alleviate post-operative hyperamylasemia and improve their life standard within 6 hours and 24 hours, respectively. Indomethacin is suitable for individuals who underwent simple, short-duration ERCP with expected mild post-operative abdominal pain, whereas somatostatin is given to patients with complicated, long-duration ERCP and expected severe post-operative abdominal pain. Their combinational therapy produces a synergistic effect and can reduce the incidence of hyperamylasemia, thereby improving patients’ quality of life within 6 h and is also effective against individuals who received a more complicated, longer-duration ERCP and were expected to have severer and longer post-operative abdominal pain.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Effects of Somatostatin and Indomethacin Mono or Combination Therapy on High-risk Hyperamylasemia and Post-pancreatitis Endoscopic Retrograde Cholangiopancreatography Patients: A Randomized Study

Wu,

Xiao,

Wang

et al. 2023

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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“…[ 112 ] Rectal NSAID is the mainstay of PEP prophylaxis and its use is advocated by a number of societies. [ 49 91 113 114 ] The issue of whether the addition of PD stenting confers any advantage is under investigation in the ongoing stent versus indomethacin trial. [ 115 ]…”

Section: Pancreatitis Prophylaxis Post-ercp Pancreatitismentioning

confidence: 99%

Controversies in ERCP: Indications and preparation

et al. 2022

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The aim of the series of papers on controversies of biliopancreatic drainage procedures is to discuss the pros and cons of the varying clinical practices and techniques in ERCP and EUS for drainage of biliary and pancreatic ducts. The first part focuses on indications, clinical and imaging prerequisites before ERCP, sedation options, post-ERCP pancreatitis (PEP) prophylaxis, and other related technical topics. In the second part, specific procedural ERCP-techniques including precut techniques and its timing as well as management algorithms are discussed. In addition, controversies in EUS-guided bile duct and pancreatic drainage procedures are under preparation.

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“…In 2013, a network meta-analysis identified topical epinephrine as the most efficacious prophylaxis for PEP [8]. However, epinephrine was not retained in any of the four subsequent guidelines from large Endoscopy Societies on this topic [5,[9][10][11]. That is because the network meta-analysis included only two randomized controlled trials (RCTs); furthermore, these excluded (!)…”

Section: Target Population Timingmentioning

confidence: 99%

Should we incorporate topical epinephrine in the ESGE guideline on prevention of post-ERCP pancreatitis?

Toussaint

Dumonceau

2020

Endosc Int Open

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Chinese expert consensus on perioperative medications for endoscopic retrograde cholangiopancreatography (ERCP)

Cited by 7 publications

References 99 publications

Effects of Somatostatin and Indomethacin Mono or Combination Therapy on High-risk Hyperamylasemia and Post-pancreatitis Endoscopic Retrograde Cholangiopancreatography Patients: A Randomized Study

Effects of Somatostatin and Indomethacin Mono or Combination Therapy on High-risk Hyperamylasemia and Post-pancreatitis Endoscopic Retrograde Cholangiopancreatography Patients: A Randomized Study

Controversies in ERCP: Indications and preparation

Should we incorporate topical epinephrine in the ESGE guideline on prevention of post-ERCP pancreatitis?

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