Ewha Med J.  2006 Sep;29(2):89-97. 10.12771/emj.2006.29.2.89.

Appropriate Premedication for Prevention on Post-ERCP Pancreatitis: A Randomized and Prospective Study

• Yi SY

• KMID: 1964006
• DOI: http://doi.org/10.12771/emj.2006.29.2.89

Abstract

OBJECTIVES
Pancreatitis is the most common and serious complication of ERCP. On the basis of several reports, corticosteroid, octreotide, or calcium channel blocker might be effective in this regard. The aim of this study was to determine whether the phamacologic agents(steroid, variable amount of octreotide, and verapamil) prevent post-ERCP pancreatitis.
METHODS
A total of 80 patients were randomized. All patients received intravenously gabexate mesilate(Foy(R)) before endoscopy. Group 1 has been dose of octreotide (0.2mg blous and 6mg intravenous infusion) in group 3, and verapamil in group 4. Clinical outcomes and risk factors were analysed in each groups. We checked cytokines (IL-1, TNF-alpha) in group 3 and 4 compared with control and alcohol induced pacreatitis.
RESULTS
The overall frequency of hyperamylasemia and pancreatitis were 35% (28/80) and 13.7% (11/80), respectively. There was no difference among 4 groups with the incidence and severity of pancreatitis. The groups were similar with regard to demographic characteristics, type of procedure performed(diagnostic or therapeutic), the presence of diverticulum, visualization of pancreatic duct. There was no risk factors of ERCP-pancreatitis in all groups. In the cytokine data, TNF-alpha was markedly decreased on right after ERCP in patients with hyperamyasemia and pancreatitis.
CONCLUSION
Prophylactic administered corticosteroid, octredtid, or verpamil would not be helpful for prevention in post-ERCP pancreatitis. Also IL-1 and TNF-alpha may not be useful markers in prediction of ERCP-pancretitis. But TNF-alpha would be useful marker as mild form ERCP-pancreatitis and alcoholic pancreatitis.

Keyword

Premedication; Corticosteroid; Octreotide; Verapamil; Post-ERCP pancreatitis

MeSH Terms

Calcium Channels
Cholangiopancreatography, Endoscopic Retrograde
Cytokines
Diverticulum
Endoscopy
Gabexate
Humans
Hyperamylasemia
Incidence
Interleukin-1
Octreotide
Pancreatic Ducts
Pancreatitis*
Pancreatitis, Alcoholic
Premedication*
Prospective Studies*
Risk Factors
Tumor Necrosis Factor-alpha
Verapamil
Calcium Channels
Cytokines
Gabexate
Interleukin-1
Octreotide
Tumor Necrosis Factor-alpha
Verapamil