Gabexate or somatostatin administration before ERCP in patients at high risk for post-ERCP pancreatitis: A multicenter, placebo-controlled, randomized clinical trial

Andriulli, Angelo; Clemente, R.; Solmi, L.; Terruzzi, Vittorio; Suriani, Renzo; Sigillito, Angelo; Leandro, Gioacchino; Leo, Pietro; Maio, Giovanni; Perri, Francesco

doi:10.1067/mge.2002.128130

Cited by 44 publications

(32 citation statements)

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“…The rationale of nonsteroid anti-inflammatory drugs (NSAIDs) for PEP is based on its ability to inhibit inflammatory substances in the early phase of pancreatitis, such as prostaglandins, phospholipase A2, and a neutrophil-endothelial interaction (21). Three meta-analyses demonstrated a decrease in of the incidence of PEP with the use of rectal NSAIDs with no adverse side-effects (22)(23)(24) (25) conducted an updated and comprehensive metaanalysis on NSAIDs in preventing PEP, in which data from the latest trials were also included.…”

Section: Discussionmentioning

confidence: 99%

Rectal indomethacin for the prevention of post-ERCP pancreatitis: A meta-analysis of randomized controlled trials

Shi¹,

Deng²,

Altaf³

et al. 2015

Turk J Gastroenterol

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Background/Aims: This meta-analysis was undertaken to evaluate the effect of rectal indomethacin in the prevention of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. Materials and Methods: Major databases including Embase, Medline, Science Citation Index Expanded, Pubmed and the Cochrane Central Register of Controlled Trials, were searched to identify all relevant studies from January 1960 to July 2013. Randomized controlled trials (RCTs) comparing prophylactic use of rectal indomethacin versus placebo were included. Risk ratio (RR) with 95% confidence interval (CI) was calculated using fixed-or randomeffect models. Results: Three studies met the inclusion criteria and were included in the final analyses. The overall incidence of post-ERCP pancreatitis (PEP) was significantly decreased by prophylactic rectal indomethacin compared with the placebo (RR=0.51; 95% CI=0.37-0.70). The pooled incidence of moderate to severe pancreatitis was also decreased by rectal indomethacin prophylaxis (RR=0.43; 95% CI=0.23-0.80). Conclusion: Rectal indomethacin can reduce the overall incidence and the severity of PEP.

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Section: Discussionmentioning

confidence: 99%

Rectal indomethacin for the prevention of post-ERCP pancreatitis: A meta-analysis of randomized controlled trials

Shi¹,

Deng²,

Altaf³

et al. 2015

Turk J Gastroenterol

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“…Various pharmacological agents (such as nifedipine, glucagon, calcitonin, lidocaine, nitroglycerine, antibiotics, steroids, allopurinol, interleukin-10, and heparin) have been tried, but have met with disappointing results in preventing pancreatitis in randomized controlled trials [1,[22][23][24][25][26][27][28][29][30][31][32][33][34] . Only two agents seem to offer any clinical benefit: the protease inhibitor gabexate mesilate [35][36][37] and the antisecretory agent somatostatin may be efficacious in preventing pancreatitis when given by continuous IV infusion [34,38,39] . Since these agents require continuous and prolonged IV infusion, they are not suited for same-day outpatient ERCP [34] .…”

Section: Discussionmentioning

confidence: 99%

“…Pancreatitis is the most common complication of endoscopic retrograde cholangiopancreatography (ERCP), with a reported incidence of 1%-10% in most prospective studies [1][2][3][4][5][6][7][8][9] . The generally accepted criteria for the diagnosis of post-ERCP pancreatitis were proposed in 1991 during a consensus workshop.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of intramuscular diclofenac and fluid replacement in prevention of post-ERCP pancreatitis

Senol¹,

Sarıtaş²,

Demirkan³

2009

WJG

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AIM:To assess the efficacy of intramuscular diclofenac and fluid replacement for prevention of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. METHODS:A prospective, placebo-controlled study was conducted in 80 patients who underwent ERCP. Patients were randomized to receive parenteral diclofenac at a loading dose of 75 mg followed by the infusion of 5-10 mL/kg per hour isotonic saline over 4 h after the procedure, or the infusion of 500 mL isotonic saline as placebo. Patients were evaluated clinically, and serum amylase levels were measured 4, 8 and 24 h after the procedure. RESULTS:The two groups were matched for age, sex, underlying disease, ERCP findings, and type of treatment. The overall incidence of pancreatitis was 7.5% in the diclofenac group and 17.5% in the placebo group (12.5% in total). There were no significant differences in the incidence of pancreatitis and other variables between the two groups. In the subgroup analysis, the frequency of pancreatitis in the patients without sphincter of Oddi dysfunction (SOD) was significantly lower in the diclofenac group than in the control group (P = 0.047).CONCLUSION: Intramuscular diclofenac and fluid replacement lowered the rate of pancreatitis in patients without SOD.

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“…A variety of patient-related and procedure-related factors implicated in complications of EST have already been reported in several single-and multi-centre prospective large series of patients [3,13,15,18,22]. Pancreatic contrast injection was an independent risk factor for post ERCP-pancreatitis in many previous studies [14,18,19,21,23,25].…”

Section: Discussionmentioning

confidence: 88%

“…Cheng and co-workers [18] published an overall pancreatitis rate of 15.1% but their survey contained a high proportion of suspected SOD (33.9%). In previous prospective large-scale risk factor studies, the proportion of SOD patients was usually less than 10% [3,[19][20][21][22][23].…”

Section: Discussionmentioning

confidence: 98%

Quality assurance of sphincterotomy: A prospective single-centre survey

et al. 2011

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AbstractQuality assurance becomes an increasingly important part of clinical medicine and of the field of endoscopy. Endoscopic sphincterotomy is associated with a fairly high complication rate. We aimed to assess our quality of sphincterotomy for benchmarking by using a prospective electronic database registry, and to identify potential risk factors for post-interventional complications. Over 2 years, 471 sphincterotomies were performed in a single tertiary referral centre. Patient- and procedure-related variables were prospectively recorded with the support of a multi-centre international sphincterotomy registry. Multivariate analysis was performed. The overall post-interventional complication rate was 9.3%. Pancreatitis happened in 5.5%, bleeding in 2.1%, perforation in 1.3%, and cholangitis in 0.4%. In the multivariate analysis following variables remained highly significant and predictive for complications: ‘papilla only in lateral view’ (p=0.001), antiplatelet therapy (p=0.024), and opacification with contrast up to the pancreatic tail (p=0.001). The primary success rate of sphincterotomy was 95.1%. The rate of post-interventional pancreatitis did not differ significantly regardless of the presence of prophylactic pancreatic stent (p=0.56). The outcome of sphincterotomy in our centre matches with literature data. The extent of pancreatic duct opacification has an influence on the pancreatitis rate. Prevention of pancreatitis by inserting pancreatic stents is not confirmed.

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Gabexate or somatostatin administration before ERCP in patients at high risk for post-ERCP pancreatitis: A multicenter, placebo-controlled, randomized clinical trial

Cited by 44 publications

References 0 publications

Rectal indomethacin for the prevention of post-ERCP pancreatitis: A meta-analysis of randomized controlled trials

Rectal indomethacin for the prevention of post-ERCP pancreatitis: A meta-analysis of randomized controlled trials

Efficacy of intramuscular diclofenac and fluid replacement in prevention of post-ERCP pancreatitis

Quality assurance of sphincterotomy: A prospective single-centre survey

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