Antisecretory agents for prevention of post-ERCP pancreatitis: rationale for use and clinical results.
نویسندگان
چکیده
Acute pancreatitis is the most common complication of endoscopic retrograde cholangiopancreatography (ERCP). Over the past decade, there has been notable research on the use of various prophylactic agents in preventing post-ERCP pancreatitis. The most widely investigated drug is the antisecretory agent somatostatin and its analogue octreotide. Both agents are potent inhibitors of exocrine secretion of the pancreas, which plays an important role in the pathogenesis of acute pancreatitis by causing autodigestion of pancreas. In addition, somatostatin and octreotide appear to have anti-inflammatory and cytoprotective effects, both of which may be protective against post-ERCP pancreatitis. Furthermore, somatostatin has been shown to relax the sphincter of Oddi, whereas octreotide increases the basal pressure of the sphincter. Several randomized controlled trials have evaluated the efficacy of somatostatin and octreotide in reducing post-ERCP pancreatitis. The results of these trials vary due to different patient populations and experimental designs. Overall, the available evidence suggests that somatostatin reduces the incidence of post-ERCP pancreatitis, whereas octreotide does not. Whether the difference in efficacy between the two drugs is related to their differential effects on sphincter of Oddi motility or is due to other reasons remains unclear. Although there is some evidence supporting the use of somatostatin in reducing the frequency of post-ERCP pancreatitis, it is widely agreed that generalized treatment of all patients undergoing ERCP with prophylactic somatostatin may not be cost-effective. Further studies should focus on the elucidation of the most cost-effective dosage regimen of somatostatin and it efficacy in patients at high risk for post-ERCP pancreatitis.
منابع مشابه
Antiproteasic agents in the prevention of post-ERCP pancreatitis: rationale for use and clinical results.
متن کامل
Antisecretory vs. antiproteasic drugs in the prevention of post-ERCP pancreatitis: the evidence-based medicine derived from a meta-analysis study.
Uncertainties still exist about the clinical benefit of pharmacological prevention of post-ERCP pancreatitis by either antisecretory drugs such as somatostatin and its long-acting analogue octreotide, or protease inhibitors such as gabexate mesilate. Recent, large-scale prospective studies have reported a fourfold reduction in acute pancreatitis as compared to a placebo with the prophylactic ad...
متن کاملEvaluation of guide wire cannulation in reduced risk of post - ERCP pancreatitis and facilitated bile duct cannulation
Background: Pancreatitis is most common complication of post-ERCP and needs to admission at least for one day. The purpose of this study was to assess the efficacy of guide wire for better common bile duct (CBD) cannulation for reducing post-ERCP pancreatitis. Methods: From April 2010 through March 2011, the patients who needed ERCP and referred to Shahid Beheshti and Rouhani Teaching Hospita...
متن کاملPrevention of Postendoscopic Retrograde Cholangiopancreatography Pancreatitis: The Endoscopic Technique
Pancreatitis is the most frequent and distressing complication of endoscopic retrograde cholangiopancreatography (ERCP). Many recent studies have reported the use of pharmacological agents to reduce post-ERCP pancreatitis (PEP); however, the most effective agents have not been established. Reduction in the incidence of PEP in high-risk patients has been reported through specific cannulation tec...
متن کاملRole of Rectal Diclofenac Suppository for Prevention and Its Impact on Severity of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis in High-Risk Patients
BACKGROUND The aim was to study the role of rectal diclofenac in prevention of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis and its impact on severity of post-ERCP pancreatitis. METHODS We conducted a single-center, prospective, open-labeled, randomized trial for evaluating the use of rectal diclofenac in prevention of post-ERCP pancreatitis in high-risk patients. W...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید
ثبت ناماگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید
ورودعنوان ژورنال:
- JOP : Journal of the pancreas
دوره 4 1 شماره
صفحات -
تاریخ انتشار 2003