Octreotide 24‐h prophylaxis in patients at high risk for post‐ERCP pancreatitis: results of a multicenter, randomized, controlled trial

Abstract

The main questions still debated relating to the diagnostic and therapeutic endoscopic procedures involving Vater's papilla (ERCP) are post-procedure pancreatitis and its prevention. Acute post-ERCP pancreatitis is still the most frequent and feared complication. A recent review of prospective series found a mean prevalence of 5.2% after diagnostic procedures and 4.1% after therapeutic procedures. 1 However, in recent prospective studies in non-selected cases the rate of this complication has been reported to range widely, from 1.3% to 7.6%. 2±9 The varying SUMMARYBackground: Pharmacological prophylaxis of post-ERCP pancreatitis is costly and not useful in most non-selected patients, in whom the incidence of pancreatitis is 5% or less. However, it could be useful and probably costeffective, in patients at high risk for this complication, where the post-procedure pancreatitis rate is 10% and more. Aim: To assess the ef®cacy of octreotide in reducing the incidence and severity of post-ERCP pancreatitis and procedure-related hospital stay, in subjects with known patient-related risk factors. Methods: A total of 120 patients were randomly allocated to receive octreotide or not, in a multicentre, randomized, controlled trial. The drug was given subcutaneously, 200 lg t.d.s., starting 24 h before the ERCP procedure, in patients with either sphincter of Oddi dysfunction, or a history of relapsing pancreatitis

New advances in acute pancreatitis

“…Milewski et al confirmed that N-acetylcysteine was ineffective [40]. Two groups conducted an RCT and claimed that octreotide prevented post-ERCP pancreatitis [41,42], but two groups previously showed that octreotide was ineffective [48,49], corroborating negative findings of a meta-analysis of 10 other clinical trials [50]. The variable results of the octreotide studies are likely due to marked differences among the studies such as drug dose and duration, population, endpoints, etc.…”

Faster Rate of Initial Fluid Resuscitation in Severe Acute Pancreatitis Diminishes In-Hospital Mortality

“…Pharmacologic agents directed at decreasing pancreatic secretions, including histamine-2 receptor antagonists and octreotide, antiprotease therapies such as aprotinin and gabexate mesylate, and platelet-activating factor antagonists such as lexipafant, have not proven effective in improving important clinical outcomes [5,6,7,8]. Adequate analgesia, monitoring for complications and aggressive intravenous fluid resuscitation remain the hallmarks of therapy.…”

Effects of Octreotide Pretreatment in Experimental Acute Pancreatitis

“…In the clinical setting recent randomized controlled trials have failed to demonstrate beneficial effects of octreotide pretreatment in the prevention of post-ERCPinduced pancreatitis [22,23]. In fact, according to the findings of the present study, it might actually be harmful to pretreat patients with octreotide prior to ERCP because should they develop pancreatitis it may be more severe.…”