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The Ewha Medical Journal
Ewha Womans University School of Medicine

Ewha Med J 2006; 29(2):89-97

pISSN: 1598-7450

DOI: https://doi.org/10.12771/emj.2006.29.2.89

Original Article

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

Sun Young Yi

Copyright ⓒ 2006. Ewha Womans University School of Medicine. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Published Online: Sep 30, 2006

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®) 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-α) 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-α 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-α may not be useful markers in prediction of ERCP-pancretitis. But TNF-α would be useful marker as mild form ERCP-pancreatitis and alcoholic pancreatitis.

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