Assessment of Pharmacological Prophylaxis for Acute Pancreatitis Following ERCP in Patients with Choledoholithiasis
Endoscopic retrograde cholangiopancreatography (ERCP) is an effective tool in the diagnostics and treatment of bile duct diseases. Although minimally invasive, the procedure is associated with a risk of complications, with acute pancreatitis being the most serious. In recent years, high hopes have been placed on pharmacological prevention of acute pancreatitis after ERCP. The aim of the study was assessment of the efficacy of low-molecular-weight heparin and somatostatin in combination with diclofenac in the prevention of acute pancreatitis after ERCP. Material and methods. The study enrolled three groups of 30 patients diagnosed with cholelithiasis; group I: patients who received low-molecular-weight heparin prior to ERCP, group II: patients who received somatostatin and diclofenac, group III: control group. The study assessed the incidence of acute pancreatitis, hyperamylasemia and increased CRP levels. Results. Acute pancreatitis was observed in 13.3% of group I patients, 10% of group II patients and 16.7% of group III patients (no statistical significance). Hyperamylasemia was observed in 16.7% of group I patients, 16.7% of group II patients and 43.3% of group III patients. These differences were statistically significant. No significant differences were found in the occurrence of increased CRP levels among the study groups. Conclusions. No significant reduction in the occurrence of acute pancreatitis after ERCP was observed in patients who received pharmacological prophylaxis. A significant reduction in the occurrence of hyperamylasemia was found in drug-treated patients.
- Department of General and Oncological Surgery, Kutno Local Government Hospital (Non-public Health Care Institution, Kierownik: dr n. med. Z. Adamczyk , email@example.com
- Department of General and Endocrine Surgery, Medical University in Łódź, Kierownik: prof. dr hab. K. Kuzdak
- 1. Baillie J: Training in advanced pancreaticobiliary endoscopy: why, how, and will we even need ERCP in the future? Tech Gastrointest Endosc 2004; 6:100‑06.[Crossref]
- 2. Attili AF, Capocaccie R, Carruli N et al.: Factors associated with gallstone disease in the MICOL experience. Multicenter Italian Study on Epidemiology of Cholelithiasis. Hepatology 1997; 26 (4): 809‑18.[Crossref]
- 3. Attam R, Freeman ML: Endoscopic papillary large balloon dilation for large common bile duct Stones. J Hepatobiliary Pancreat Surg 2009; 16: 618‑23.
- 4. Piotrowska-Staworko G, Świdnicka-Siergiejko A, BaniukiewiczA, Dąbrowski A: Powikłania po endoskopowej cholangiopankreatografii wstecznej. Gastroenterol Pol 2007; 14 (4): 307‑12.
- 5. Cotton PB, Garrow DA, Gallagher J, Romagnuolo J:. Risk factors for complication safter ERCP: a multivariate analysis of 11,497 procedures over 12 years. Gastrointest Endosc 2009 70 (1): 80‑88.[WoS]
- 6. Testoni PA, Mariani A, Masci E et al.: Frequency of post-ERCP pancreatitis in a single tertiary referral center without ant with routine prophylaxis with gabexate: a six-year survey. Dig Liv Dis 2006; 38: 588‑95.[Crossref]
- 7. Hellmig S, Fölsch UR : Pharmacologicalprevention of post-ERCP pancreatitis - aneverlasting dream? Dig Liver Dis 2006 Aug; 38 (8): 588‑95.[Crossref]
- 8. Andriulli A, Loperfido S, Napolitano G et al.: Incidencerates of post-ERCP complications: a systematic survey of prospective studies. Am J Gastroenterol 2007; 102: 1781‑88.[Crossref]
- 9. Rabenstein T, Roggenbuck S, Framke B et al.: Complications of endoscopic sphincterotomy: can heparin prevent acute pancreatitis after ERCP? Gastrointest Endosc 2002 Apr; 55 (4): 476‑83.[Crossref]
- 10. Li S, Cao G, Chen X, Wu T: Low-dose heparin in the prevention of post endoscopic retrograde cholangiopancreatography pancreatitis: a systematic review and meta-analysis. Eur J Gastroenterol & Hepatol 2012 May; 24 (5): 477‑81.[WoS][Crossref]
- 11. Ung KA , Rydberg L, Modin S et al.: A preventive effect of unfractionated heparin on post-ERCP pancreatitis is suggested by positive effects on laboratory markers. Hepatogastroenterol 2011; 58: 168‑73.
- 12. Young E: The anti-inflammatoryeffects of heparin and relatedcompounds. Thromb Res 2008; 122: 743‑52.[Crossref]
- 13. Mousa SA : Heparin, low molecular weight heparin, and derivatives in thrombosis, angiogenesis, and inflammation: emerging links. Semin Thromb Hemost 2007; 33: 524‑33.[WoS][Crossref]
- 14. Walenga JM: Non-anticoagulant effects of unfractionated and low-molecular weight heparins. Clin Adv Hematol Oncol 2007; 5: 759‑60.
- 15. Elsayed E, Becker RC: The impact of heparin compounds on cellular inflammatory responses: a construct for future investigation and pharmaceutical development. J Thromb Thrombolysis 2003; 15: 11‑18.[Crossref]
- 16. Katsinelos P, Fasoulas K, Paroutoglou G et al.: Combination of diclofenac plus somatostatin in the prevention of post-ERCP pancreatitis: a randomized, double-blind, placebo-controlledtrial. Endoscopy 2012; 44: 53‑59.[WoS][Crossref]