Rectal Indomethacin and Spraying of Duodenal Papilla With Epinephrine Increases Risk of Pancreatitis Following Endoscopic Retrograde Cholangiopancreatography

Luo, Hui; Wang, Xiangping; Zhang, Rongchun; Liang, Shuhui; Kang, Xiaoyu; Zhang, Xiaofeng; Lou, Qifeng; Xiong, Ke; Yang, Jing; Si, Li-Juan; Liu, Wenming; Liu, Yunpeng; Zhou, Yi; Wang, Suli; Yang, Mei; Chen, Wei; Han, Yan-Zhi; Shang, Guochen; Yang, Xiao; He, Yan; Zou, Qiang; Guo, Wenwei; Dai, Yichen; Zeng, Wei; Zhu, Xiaoyan; Gong, Rongqing; Li, Xun; Nie, Zhilin; Wang, Qi; Wang, Ling; Pan, Yanglin; Guo, Xiaomao; Fan, Daiming

doi:10.1016/j.cgh.2018.10.043

Cited by 27 publications

(33 citation statements)

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“…Initial search revealed 109 articles, of which eight studies, including six RCTs and two observational studies with 4123 patients were included in this systematic review and meta-analysis [19][20][21][25][26][27][28][29]. ▶ Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Although some of the above studies have shown beneficial outcomes with use of topical epinephrine in preventing PEP, some have failed to show any significant difference in incidence of PEP. Luo et al, in a randomized double-blind multicenter trial, which included 1158 patients, found a higher incidence of PEP in patients who received epinephrine and rectal indomethacin compared to patients who received rectal indomethacin alone (8.5 % vs. 5.3 %) [25]. Similarly, Kamal et al in a multicenter double-blinded randomized trial, showed no significant difference in incidence of PEP in patients who received indomethacin alone compared to a combination of indomethacin and epinephrine (6.4 % in indomethacin group vs 6.7 % in combination group) [19].Considering current evidence and results of our meta-analysis, we do not recommend use of topical epinephrine in addition to rectal indomethacin for the prevention of PEP.…”

Section: Discussionmentioning

confidence: 99%

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Post-endoscopic retrograde cholangiopancreatography pancreatitis prevention using topical epinephrine: systematic review and meta-analysis

et al. 2020

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Background and study aims Post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) is a common complication of endoscopic retrograde cholangiopancreatography (ERCP). Multiple drugs and techniques have been studied for the prevention of PEP. Topical epinephrine has shown mixed results and is still not widely accepted as an alternative for prevention of PEP. We performed a systematic review and meta-analysis to evaluate the efficacy of topical epinephrine in preventing PEP. Methods A comprehensive literature review was conducted by searching Cochrane library database, Embase and PubMed up to August 2019, to identify all studies that evaluated use of topical epinephrine alone or in conjunction with other agents for prevention of PEP. Outcomes included prevention of PEP with use of topical epinephrine and evaluation of whether addiing epinephrine provides any additional benefit in preventing PEP. All analysis was conducted using Revman 5.3. Results Eight studies, including six randomized controlled trials and two observational studies with 4123 patients, were included in the meta-analysis. Overall, there was no difference in incidence of PEP in patients who underwent ERCP and were treated with epinephrine spray versus those who were not, RR = 0.63 (CI 0.32–1.24) with heterogeneity (I2 = 72 %). However, on a subgroup analysis, topical epinephrine significantly decreases the risk of PEP when compared to placebo alone (means no intervention was done including no rectal indomethacin)., RR = 0.32 (0.18–0.57). In another subgroup analysis, there was no statistically significant difference in using topical epinephrine along with rectal indomethacin in preventing PEP compared to rectal indomethacin alone RR = 0.87 (0.46–1.64). Conclusion Topical epinephrine does not provide any additional benefit in preventing PEP when used in conjunction with rectal indomethacin. In subgroup analysis, topical epinephrine appeared to decrease risk of PEP in the absence of rectal indomethacin, and could be considered when rectal indomethacin is unavailable or if there is a contraindication to its use.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Post-endoscopic retrograde cholangiopancreatography pancreatitis prevention using topical epinephrine: systematic review and meta-analysis

et al. 2020

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“…Data of this study were retrieved from two large multicenter randomized controlled trials (RCTs) (NCT02002650 and NCT03057769). Patients aged 18–90 years with native papilla who underwent trainee‐involved ERCP were eligible for the study.…”

Section: Methodsmentioning

confidence: 99%

Patient‐related factors associated with successful cannulation by trainees during hands‐on endoscopic retrograde cholangiopancreatography training

Zheng

Wang

Ren

et al. 2019

Digestive Endoscopy

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Background and Aim Hands‐on endoscopic retrograde cholangiopancreatography (ERCP) training is essential for trainees to grasp the technique. Cannulation success rate (CSR) is considered one of the main indicators of competency of trainees. We aimed to investigate whether patient‐related factors had an impact on the CSR of trainees. Methods A post hoc analysis of data from two multicenter studies (NCT02002650 and NCT03057769) was conducted. Patients aged 18–90 years with native papilla undergoing ERCP were eligible for this study. Only procedures involving trainees in centers strictly following “10‐min criteria” for initial cannulation were enrolled. Primary outcome was CSR by trainees. Results From December 2013 to October 2017, 20 trainees in four centers were involved in initial cannulation in 1044 patients with native papilla. Primary CSR by trainees was 61.0% (436/715), 31.5% (70/222) and 44.9% (48/107) in patients with common bile duct stone (CBDS), biliary stricture (BS) and other indications, respectively (P < 0.001). In multivariate analysis, indication of BS (OR, 0.31; 95% CI, 0.22–0.44; P < 0.001) and presence of type A diverticulum (OR, 1.69; 95% CI, 1.23–2.33; P = 0.001) were both independently associated with cannulation success of trainees. Biliary infection was significantly higher in the BS than in the CBDS group (3.6% vs 0.7%, P = 0.004), whereas other post‐ERCP complications were comparable between the two groups. Conclusions Indication of BS and the presence of type A diverticulum were independently associated with the success of cannulation by trainees. These findings indicate that greater effort is needed for trainees to improve the ability of cannulation in BS.

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“…Gallstones remain the most common cause of AP, while up to 25% to 30% of cases can be attributed to alcohol [7]. Despite these two more frequent etiologies, other factors, in 10% of the cases that are described, can influence the severity, such as endoscopic retrograde cholangiopancreatography [23], renal failure [24], diabetes [25], obesity [26], tobacco [27], drugs and toxins [28], genetic factors [29], trauma [30], autoimmune [31], and hyperlipidemia [32].…”

Section: Murine Models and The Etiology Of Acute Pancreatitismentioning

confidence: 99%

Murine Models of Acute Pancreatitis: A Critical Appraisal of Clinical Relevance

Silva-Vaz

Abrantes

Castelo‐Branco

et al. 2019

IJMS

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Acute pancreatitis (AP) is a severe disease associated with high morbidity and mortality. Clinical studies can provide some data concerning the etiology, pathophysiology, and outcomes of this disease. However, the study of early events and new targeted therapies cannot be performed on humans due to ethical reasons. Experimental murine models can be used in the understanding of the pancreatic inflammation, because they are able to closely mimic the main features of human AP, namely their histologic glandular changes and distant organ failure. These models continue to be important research tools for the reproduction of the etiological, environmental, and genetic factors associated with the pathogenesis of this inflammatory pathology and the exploration of novel therapeutic options. This review provides an overview of several murine models of AP. Furthermore, special focus is made on the most frequently carried out models, the protocols used, and their advantages and limitations. Finally, examples are provided of the use of these models to improve knowledge of the mechanisms involved in the pathogenesis, identify new biomarkers of severity, and develop new targeted therapies.

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Rectal Indomethacin and Spraying of Duodenal Papilla With Epinephrine Increases Risk of Pancreatitis Following Endoscopic Retrograde Cholangiopancreatography

Cited by 27 publications

References 36 publications

Post-endoscopic retrograde cholangiopancreatography pancreatitis prevention using topical epinephrine: systematic review and meta-analysis

Post-endoscopic retrograde cholangiopancreatography pancreatitis prevention using topical epinephrine: systematic review and meta-analysis

Patient‐related factors associated with successful cannulation by trainees during hands‐on endoscopic retrograde cholangiopancreatography training

Murine Models of Acute Pancreatitis: A Critical Appraisal of Clinical Relevance

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