Transdermal glyceryl trinitrate for prevention of post-ERCP pancreatitis: A randomized double-blind trial

Moretó, M; Zaballa, Manuel; Casado, I.; Merino, Olga; Rueda, Miguel; Ramirez, Kleber; Urcelay, Raquel; Baranda, Ana

doi:10.1067/mge.2003.29

Cited by 90 publications

(36 citation statements)

References 30 publications

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“…An ideal agent is highly effective in reducing pancreatitis, is safe for the patient, well tolerated, relatively affordable, and does not have a prolonged administration time [1] . 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] .…”

Section: Discussionmentioning

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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Section: Discussionmentioning

confidence: 99%

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

Senol¹,

Sarıtaş²,

Demirkan³

2009

WJG

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“…Initial trials studying the effect of GTN (transdermal or sublingual) showed promise [85,86] but three subsequent randomised trials demonstrated no significant preventive effect on post-ERCP pancreatitis [87][88][89] . Numerous other drugs have been studied with disappointing or conflicting results.…”

Section: Inhibition Of Protease Activitymentioning

confidence: 99%

Prevention of post-ERCP pancreatitis

Wong

Tsai

2014

WJGP

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Post-procedure pancreatitis is the most common complication of endoscopic retrograde cholangio pancreatography (ERCP) and carries a high morbidity and mortality occurring in at least 3%-5% of all procedures. We reviewed the available literature searching for "ERCP" and "pancreatitis" and "post-ERCP pancreatitis". in PubMed and Medline. This review looks at the diagnosis, risk factors, causes and methods of preventing post-procedure pancreatitis. These include the evidence for patient selection, endoscopic techniques and pharmacological prophylaxis of ERCP induced pancreatitis. Selecting the right patient for the procedure by a risk benefits assessment is the best way of avoiding unnecessary ERCPs. Risk is particularly high in young women with sphincter of Oddi dysfunction (SOD). Many of the trials reviewed have rather few numbers of subjects and hence difficult to appraise. Meta-analyses have helped screen for promising modalities of prophylaxis. At present, evidence is emerging that pancreatic stenting of patients with SOD and rectally administered nonsteroidal anti-inflammatory drugs in a large unselected trial reduce the risk of post-procedure pancreatitis. A recent meta-analysis have demonstrated that rectally administered indomethecin, just before or after ERCP is associated with significantly lower rate of pancreatitis compared with placebo [OR = 0.49 (0.34-0.71); P = 0.0002]. Number needed to treat was 20. It is likely that one of these prophylactic measures will begin to be increasingly practised in high risk groups.© 2014 Baishideng Publishing Group Co., Limited. All rights reserved. Key words: Acute pancreatitis; Endoscopic retrograde cholangio pancreatographyCore tip: Select patients carefully, and give high risk patients rectal indomethacin.Wong LL, Tsai HH. Prevention of post-ERCP pancreatitis.

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“…A meta-analysis of IL-10 infusion studies suggests that this agent may reduce the incidence of post ERCP pancreatitis (27) but it has been recently reported that a large, multicentre trial in the USA on high risk patients has been abandoned due to lack of efficacy of IL-10 (24). Two randomised studies support the use of glyceryl trinitrate as a chemoprevention agent for post ERCP pancreatitis (28,29). This drug is thought to act by relaxing the sphincter of Oddi and may be administered via a slow release skin patch.…”

Section: Pharmacological Prophylaxis For Post Ercp Pancreatitismentioning

confidence: 99%

Reducing the Incidence and Severity of Post Ercp Pancreatitis

2005

Scand J Surg

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Acute pancreatitis remains the commonest complication of ERCP (endoscopic retrograde cholangiopancreatography) with published incidence rates that have changed little over 30 years despite significant advances in endoscope and ERCP accessory technology and the introduction of structured ERCP training. Technique related risk factors for post ERCP pancreatitis have been recognised for many years and have been recently refined via large prospective audits. These studies have also revealed the importance of patient related factors and highlighted the high incidence of post ERCP pancreatitis in women being investigated for acalculus biliary pain or idiopathic recurrent acute pancreatitis. Sphincter of Oddi hypertension is often found to be present in this group of patients. Methods of preventing post ERCP pancreatitis have been sought for many years and numerous drugs have been tried using a variety of regimes with heterogeneous groups of patients. At present pancreatic duct stenting looks to be the most efficacious prophylactic method but is not for the beginner endoscopist. It is possible, however, by using a simple strategy to minimise the incidence of post ERCP pancreatitis and modulate its severity.

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Transdermal glyceryl trinitrate for prevention of post-ERCP pancreatitis: A randomized double-blind trial

Cited by 90 publications

References 30 publications

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

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

Prevention of post-ERCP pancreatitis

Reducing the Incidence and Severity of Post Ercp Pancreatitis

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