Oral allopurinol does not prevent the frequency or the severity of post-ERCP pancreatitis

Mosler, Patrick; Sherman, Stuart; Marks, Jeffrey M.; Watkins, James L.; Geenen, Joseph E.; Jamidar, Priya A.; Fogel, Evan L.; Lazzell–Pannell, Laura; Temkit, MʼHamed; Tarnasky, Paul R.; Block, Kevin P.; Frakes, James T.; Aziz, Arif; Malik, Pramod; Nickl, Nicholas; Slivka, Adam; Goff, John S.; Lehman, Glen A.

doi:10.1016/s0016-5107(05)01572-5

Cited by 46 publications

(44 citation statements)

References 20 publications

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“…Katsinelos et al [111] , reported that pretreatment with high-dose, orally administered allopurinol decreases the frequency of PEP (3% in allopurinol group compared to 18% in placebo group). Moseler and colleagues, in another large-scale trial found no statistical difference in the frequency of PEP in patients given allopurinol (13%) compared with those given a placebo (12%) [112] . Budzynska et al [106] reported similar rates of pancreatitis in 200 patients who received either allopurinol (12%) or placebo (8%).…”

Section: Category 3: Markers Of Systemic Inflammationmentioning

confidence: 95%

Pancreatits after endoscopic retrograde cholangio-pancreatography

Aziz

Lehman

2007

WJG

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Pancreatitis is the most common complication after endoscopic retrograde cholangio-pancreatography (ERCP); the reported incidence of this complication varies from less than 1% to 40%, but a rate of 4%-8% is reported in most prospective studies involving nonselected patients. Differences in criteria for defining pancreatitis, methods of data collection, and patient populations (i.e. number of high-risk patients included in the published series) are factors that are likely to affect the varying rates of post-ERCP pancreatitis. The severity of post-ERCP pancreatitis (PEP) can range from a minor inconvenience with one or two days of added hospitalization with full recovery to a devastating illness with pancreatic necrosis, multiorgan failure, permanent disability, and even death. Although, most episodes of PEP are mild (about 90%), a small percentage of patients (about 10%) develop moderate or severe pancreatitis. In the past, PEP was often viewed as an unpredictable and unavoidable complication, with no realistic strategy for its avoidance. New data have aided in stratification of patients into PEP risk categories and new measures have been introduced to decrease the risk of PEP. As most ERCPs are performed on an outpatient basis, the majority of patients will not develop PEP and can be discharged. Alternatively, early detection of those patients who will go on to develop PEP can guide decisions regarding hospital admission and aggressive management. In the last decade, great efforts have been addressed toward prevention of this complication. Points of emphasis have included technical measures, pharmacological prophylaxis, and patient selection. This review provides a comprehensive, evidence-based assessment of published data on PEP and current suggestions for its avoidance.© 2007 The WJG Press. All rights reserved.Key words: Endoscopic retrograde cholangiopancreatography; Post-ERCP pancreatitis Abdel Aziz AM, Lehman GA. Pacreatitis after endoscopic r e t r o g r a d e c h o l a n g i o -p a n c r e a t o g r a p h y . W o r l d J

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Section: Category 3: Markers Of Systemic Inflammationmentioning

confidence: 95%

Pancreatits after endoscopic retrograde cholangio-pancreatography

Aziz

Lehman

2007

WJG

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“…Allopurinol, a xanthine oxidase inhibitor, was not found superior to placebo in the prevention of PEP and hyperamylasemia in a prospective randomized trial and two meta-analyses (121)(122)(123). Whereas in a randomized controlled trial (124), when it was given orally in high dose 3 and 15 hours before ERCP, it significantly decreased PEP (3.2% vs. 17.8%).…”

Section: Drugs Reducing Inflammationmentioning

confidence: 91%

Prevention of post-ERCP pancreatitis

Sarıtaş¹,

Üstündağ

Baron

2011

Turk J Gastroenterol

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“…These studies were meta-analyzed for their primary PEP outcome. The summary RR for "prevention of all kinds of pancreatitis" in the four trials [30,32,34,36] was 0.86 with a 95% CI of 0.42-1.77 and a non-significant RR (P = 0.6801, Figure 1A). The Cochrane Q test for heterogeneity indicated that the studies were heterogenous (P = 0.0062, Figure 1B) and could not be combined.…”

Section: Antioxidants In Pepmentioning

confidence: 99%

Antioxidant therapy in the management of acute, chronic and post-ERCP pancreatitis: A systematic review

Monfared¹,

Vahidi²,

Abdolghaffari³

et al. 2009

WJG

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We systematically reviewed the clinical trials which recruited antioxidants in the therapy of pancreatitis and evaluated whether antioxidants improve the outcome of patients with pancreatitis. Electronic bibliographic databases were searched for any studies which investigated the use of antioxidants in the management of acute pancreatitis (AP) or chronic pancreatitis (CP) and in the prevention of post-endoscopic retrograde cholangio-pancreatography (post-ERCP) pancreatitis (PEP) up to February 2009. Twenty-two randomized, placebo-controlled, clinical trials met our criteria and were included in the review. Except for a cocktail of antioxidants which showed improvement in outcomes in three different clinical trials, the results of the administration of other antioxidants in both AP and CP clinical trials were incongruent and heterogeneous.Furthermore, antioxidant therapy including allopurinol and N-acetylcysteine failed to prevent the onset of PEP in almost all trials. In conclusion, the present data do not support a benefit of antioxidant therapy alone or in combination with conventional therapy in the management of AP, CP or PEP. Further double blind, randomized, placebo-controlled clinical trials with large sample size need to be conducted.

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Oral allopurinol does not prevent the frequency or the severity of post-ERCP pancreatitis

Cited by 46 publications

References 20 publications

Pancreatits after endoscopic retrograde cholangio-pancreatography

Pancreatits after endoscopic retrograde cholangio-pancreatography

Prevention of post-ERCP pancreatitis

Antioxidant therapy in the management of acute, chronic and post-ERCP pancreatitis: A systematic review

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