Somatostatin for prevention of post-ERCP pancreatitis: a randomized, double-blind trial

Concepción-Martín, Mar; Gómez-Oliva, Cristina; Juanes, A; Díez, Xavier; Prieto-Alhambra, Daniel; Torras, Xavier; Sainz, Sergio; Villanueva, Carmen Navarro; Farré, Antoni; Guarner-Argente, Carlos; Guarner, Carlos

doi:10.1055/s-0034-1377306

Cited by 27 publications

(17 citation statements)

References 29 publications

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“…To date, many agents are explored extensively for pharmacological potential against post-ERCP pancreatitis, such as somatostatin8, gabexate9, ulinastain10, nonsteroidal anti-inflammatory drugs (NSAIDs)1112 and octreotide13. Among these pharmacological agents available for prophylaxis, rectally administered NSAIDs, particularly indomethacin and diclofenac, have exhibited the most promising effect on prevention of post-ERCP pancreatitis14.…”

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confidence: 99%

Efficacy and safety of rectal nonsteroidal anti-inflammatory drugs for prophylaxis against post-ERCP pancreatitis: a systematic review and meta-analysis

Hou

Huang

et al. 2017

Sci Rep

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Rectal nonsteroidal anti-inflammatory drugs (NSAIDs) are not commonly used clinically for preventing post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. To evaluate the efficacy and safety of NSAIDs for post-ERCP prophylaxis, we systematically reviewed sixteen randomized controlled trials (involving 6458 patients) that compared rectal NSAIDs with placebo or no treatment for post-ERCP pancreatitis prophylaxis updated to August 2016. GRADE framework was used to assess the quality of evidence. There was “high quality” evidence that rectal NSAIDs were associated with significant reduction in the risk of overall post-ERCP pancreatitis (RR, 0.55; 95% CI, 0.42–0.71). Subgroup analyses demonstrated that diclofenac (RR, 0.41; 95% CI, 0.19–0.90) was probably superior to indomethacin (RR, 0.58; 95% CI, 0.45–0.75), post-ERCP administration (RR, 0.46; 95% CI, 0.24–0.89) was probably superior to pre-ERCP (RR, 0.53; 95% CI, 0.42–0.67), and that mixed-risk population received more benefits (RR, 0.54; 95% CI, 0.33–0.88) than average-risk population (RR, 0.60; 95% CI, 0.41–0.88), but less than high-risk population (RR, 0.41; 95% CI, 0.19–0.91). Moreover, “high quality” evidence showed that rectal NSAIDs were safe when given as a standard dose (RR = 0.80; 95% CI, 0.47–1.36). In conclusion, this meta-analysis revealed that rectal NSAIDs are effective and safe in the prevention of post-ERCP pancreatitis in populations with all levels of risk.

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confidence: 99%

Efficacy and safety of rectal nonsteroidal anti-inflammatory drugs for prophylaxis against post-ERCP pancreatitis: a systematic review and meta-analysis

Hou

Huang

et al. 2017

Sci Rep

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“…The baseline characteristics of the 11 studies published between 1998 to 2015 are presented in Supplementary Table S1 (Bordas et al, 1998; Poon et al, 1999; Andriulli et al, 2002, 2004; Poon et al, 2003; Arvanitidis et al, 2004; Chan et al, 2008; Lee et al, 2008; Wang et al, 2013; Concepción-Martín et al, 2014; Bai et al, 2015). Totally, 4192 patients undergo ERCP procedures above average age of 58 years were analyzed.…”

Section: Resultsmentioning

confidence: 99%

Role of Somatostatin in Preventing Post-endoscopic Retrograde Cholangiopancreatography (ERCP) Pancreatitis: An Update Meta-analysis

Zhang

et al. 2016

Front. Pharmacol.

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Background: Acute pancreatitis is the most common serious complication of endoscopic retrograde cholangiopancreatography (ERCP). Although, somatostatin (SOM) has been used in the prevention of post-ERCP pancreatitis (PEP), the efficacy of SOM remains inconsistent.Methods: Electronic databases, including PubMed/MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), and the Science Citation Index were searched to retrieve relevant studies. Details of the study population, including patients’ characteristics, sample size, regimen of drug administration and incidence of PEP, hyperamylasemia and abdominal pain were extracted by two investigators. Data were analyzed with Review Manager 5.3 software.Results: Eleven randomized controlled trials, enrolling a total of 4192 patients, were included in the meta-analysis. After data were pooled, we observed decreased incidence of ERCP-induced outcomes, such as PEP (RR = 0.63, 95% CI: 0.40, 0.98; P = 0.04) and hyperamylasemia (RR = 0.75, 95% CI: 0.66, 0.84; P < 0.001) in patients treated with SOM than those with placebo. Subgroup analysis by ethnicity found decreased incidence of PEP and hyperamylasemia in Asia only. Subgroup analysis by treatment schedule and dosage revealed decreased incidence of PEP and hyperamylasemia when SOM were treated with a single bolus or long-term infusion, or at dose above 3000 μg. We did not observed efficacy of SOM on abdominal pain in pooled or subgroup analysis.Conclusion: This meta-analysis of patients undergoing ERCP showed reduced incidence of PEP and hyperamylasemia when SOM was administrated with single bolus, long-term infusion, or high dosage. More data are needed to confirm our findings.

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“…A szomatosztatinnak a PEP megelőzésében játszott szerepe máig tisztázatlan, a két legutóbb közzétett véletlen bevá-lasztásos, ellenőrzött tanulmány ellentétes következte-ÖSSZEFOGLALÓ KÖZLEMÉNY tésre jutott [39,40]. A nitrát, különösen sublingualisan adva, a PEP megelőzésében hatékonynak tűnik [41], és egy tanulmányban bizonyították, hogy indometacinnal együtt alkalmazva a preventív hatás fokozódik [42].…”

Section: A Pep Gyógyszeres Megelőzéseunclassified

Az endoszkópos retrográd cholangiopancreatographiát követő heveny hasnyálmirigy-gyulladás megelőzése

et al. 2015

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Állomány-egészségtani és Állatorvosi Etológia Tanszék, BudapestMagyarországon az évente elvégzett több mint 14 000 endoszkópos retrográd cholangiopancreatographia következ-tében hozzávetőlegesen 1400 pancreatitis kialakulásával, ezen belül 10 beteg halálával kell számolni. A szerzők átte-kintik az endoszkópos retrográd cholangiopancreatographiát követő heveny hasnyálmirigy-gyulladás megelőzésére vonatkozó szakirodalmat, ismertetik saját tapasztalataikat. Utalnak a diagnosztikus endoszkópos retrográd cholangiopancreatographia háttérbe szorulására. Hangsúlyozzák a beavatkozás javallatának gondos mérlegelését, a kockázati tényezők elemzését. Fontosnak tartják a kanülálások számának csökkentését, a korai előmetszést, a nagy kockázatú betegekben a pancreasstent beültetését, az indometacin vagy a diclofenac alkalmazását és a megfelelő intravénás folyadékbevitelt. Orv. Hetil., 2015, 156(18), 715-719. Kulcsszavak: endoszkópos retrográd cholangiopancreatographia, szövődmények, post-ERCP-s pancreatitis, megelőzés Prevention of pancreatitis following endoscopic retrograde cholangiopancreatographyOver 14 000 endoscopic retrograde cholangiopancreatographies are performed in Hungary annually, and approximately 1400 patients are calculated to develop pancreatititis including 10 cases with lethal outcome. This article is aimed to review recent relevant literature and to present a practical guide based on the authors' own experience for the prevention of pancreatitis following endoscopic retrograde cholangiopancreatography. The authors emphasize the importance of careful consideration of indications, analysis of risk factors, avoiding unnecessary diagnostic intervention, a decrease of the attempts for cannulation, early precut, implantation of pancreatic stent in high risk patients, administration of rectal indomethacin or diclofenac and adequate intravenous fl uid replacement. Keywords: endoscopic retrograde cholangiopancreatography, complications, Post-ERCP pancreatitis, preventionPatai, Á., Patai, Á. V., Solymosi, N., Tulassay, Z., Herszényi, L. [Prevention of pancreatitis following endoscopic retrograde cholangiopancreatography]. Orv. Hetil., 2015, 156(18), 715-719.

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Somatostatin for prevention of post-ERCP pancreatitis: a randomized, double-blind trial

Abstract: Administration of an intravenous bolus of somatostatin followed by a short continuous infusion does not reduce the incidence of post-ERCP pancreatitis. Clinical Trials.gov number: NCT01060826.

Cited by 27 publications

References 29 publications

Efficacy and safety of rectal nonsteroidal anti-inflammatory drugs for prophylaxis against post-ERCP pancreatitis: a systematic review and meta-analysis

Efficacy and safety of rectal nonsteroidal anti-inflammatory drugs for prophylaxis against post-ERCP pancreatitis: a systematic review and meta-analysis

Role of Somatostatin in Preventing Post-endoscopic Retrograde Cholangiopancreatography (ERCP) Pancreatitis: An Update Meta-analysis

Az endoszkópos retrográd cholangiopancreatographiát követő heveny hasnyálmirigy-gyulladás megelőzése

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