Montaño LA, García CJ, González OA, Fuentes OC, Dávalos CC, Rodríguez LX

Language: Spanish
References: 26
Page: 262-268
PDF size: 87.31 Kb.

ABSTRACT

Background: Acute pancreatitis (AP) represents the main complication after endoscopic retrograde cholangiopancreatopgraphy (ERCP) and appears in 1% to 10% of the cases. The incidence increases in patients with opacification and instrumentation of pancreatic duct and it varies according to the indications of the procedure and the intervention performed. Risk factors for this complication include history of pancreatitis, difficult canulation, pancreatic acinar opacity, Oddi sphincter hypertension and sphincterotomy. Objective: Evaluate the efficacy of rectal indometacine to reduce the incidence of hyperamylasemia and AP post-ERCP. Methods and materials: Control clinical trial simple blind perfomed between June and December of 2004. One hundred seventeen patients were included in the study. They were randomly assigned in two groups: 1) study group (n = 61, 52%), 100 mg of rectal indomethacin was administered 2 hours previous to the procedure and, 2) control group (n = 56, 47.8%) received placebo (glycerine suppository). Hyperamylasemia was diagnosed with levels › 151 U/L and AP with levels › 600 U/L and characteristically abdominal pain. Results: Gender distribution was of 79 (67.5%) women and 38 (32.5%) men. Mean age was of 54.2 ± 18.8 years for the study group and 50.1 ± 18.1 years for the control group. After ERCP, 12 patients (10.2%) of the study group and 19 (16.2%) of control group presented hyperamylasemia (p = 0.09). AP was present in 3 patients (2.5%) in the study group and 8 patients (6.8%) of the control group (p = NS). There was no mortality in our study. Conclusion: The use of 100 mg of rectal indomethacine previous to ERCP decreases the risk of hyperamylasemia and AP. However, these differences did not reach statistical significance, probably because a greater sample of patients was needed.

REFERENCES

1. Nebel OT, Silvis SE, Rogers G, Sugawa C, Mandelstam P. Complications associated with endoscopic retroscopic cholangiopancreatography: results of the 1974 ASGE survey. Gastrointest Endosc 1975; 22: 34-6.

2. La Feria G, Gordoin S, Archibald M, Murray WR. Hiperamylasaemia and acute pancreatitis following retrograde cholangiography. Pancreas 1985; 1: 160-3.

3. De Palma GD, Catanzano C. Use of corticosteroids in the prevention of post-ERCP pancreatitis. Results of a controlled prospective study. Am Gastroenterol 1999; 94: 982-5.

4. Rabenstein T, Hahn EG. Post- ERCP pancreatitis: new momentum. Endoscopy 2002; 34: 325-9.

5. Vaira D, D’Anna L, Ainley C, Dowsett J, Williams S, Baillie J, Cairns S, Croker J, Salmon P, Cotton P, Russell RC, Hatfield A. Endoscopic sphincterotomy in 1000 consecutive patients. Lancet 1989; 2: 431-3.

6. Freeman ML, DiSario JA, Nelson DB, Fennery MB, Lee JG, Bjorkman DJ, Overby CS, Aas J, Ryan ME, Bochna GS, Shaw MJ, Snady HW, Erickson RV, Moore JP, Roel JP. Risk factors for post-ERCP pancreatitis: a prospective, multicenter study. Gastrointest Endosc 2001; 34: 991-7.

7. Barthet M, Lesavre N, Desjeux A, Gasmi M, Berthezene P, Berdah S, Viviand X, Grimauld JC. Complication of endoscopic sphincterotomy: results from a tertiary referral center. Endoscopy 2002; 34: 991-7.

8. Podolsky I, Haber GB, Kortan P, Gray R. Risk factors for pancreatitis following ERCP. A prospective study (Amstr). Am J Gastroenterol 1987; 82. 972A.

9. Bilbao MK, Dotter CT, Lee TG, Katon RM. Complication of endoscopic retrograde cholangiopancreatography (ERCP). A study of 10,000 cases. Gastroenterology 1976; 70: 314-20.

10. Freeman ML, Nelson DB, Sherman S, Haber GB, Herman ME, Dorsher PJ, Moore JP, Fenerty MB, Ryan ME, Shaw MJ, Lande JD, Pheley AM. Complications of endoscopic sphincterotomy. N Engl J Med 1996; 335: 909-18.

11. Messman H, Vogt W, Holstege A, Lock G, Heinish A, von Furstenberg A, Leser HG, Scholmerich J. Post ERCP pancreatitis as a model for cytokine induced acute phase response in acute pancreatitis. Gut 1997; 40: 80-5.

12. Karne S, Gorelick FS. Etiopathogenesis of acute pancreatitis. Surg Clin North Am 1999; 79: 699-710.

13. Bhatia M, Brady M, Shokuhi S, Christmas S, Neoptolemus JP, Slavin J. Inflamatory mediators in acute pancreatitis. J Pathol 2000; 190: 117-25.

14. Silvis SE, Vennes JA. The role of glucagons in ERCP. Gastrontest Endosc 1975, 21: 162-3.

15. Odes HS, Bovis BN, Bank S. Effect of calcitonin on serum amylase levels after ERCP. Digestion 1977; 16: 180-4.

16. Sand J, Norback I. Prospective randomized trial of the effect of nifedipine on pancreatic irritation after endoscopic retrograde cholangiopancreatography. Digestion 1999; 54: 105-11.

17. Arcidiacon R, Gambitta P, Rossi A, Grosso C, Bini M, Zanasi G. The use of long-acting somatostatine analogue (octreotide) for prophylaxis of acute pancreatitis after endoscopic sphincterotomy. Endoscopy 1994; 26: 715-18.

18. Dumont JA, Conwell DL, O’Connor JB, Ferguson R, Vargo JJ, Barnes DS, Shay SS, Sterling MJ, Horth KS, Issa K, Ponsky JL, Zuccaro G. Pretreatment with methylprednisolone to prevent ERCP induced pancreatitis. A randomized, multicenter, placebo controlled clinical trial. Am J Gastroenterol 1998; 93: 61-5.

19. Andriulli A, Leandro G, Niro G, Mangia A, Festa V, Gambassi G, Villani MR, Facciorusso D, Conoscitore P, Spirito F, De Malo G. Medical treatment can diminish pancreatic damage after ERCP: a meta-analysis. Gastrointest Endosc 2000; 51: 1-7.

20. Sudhindran S, Bromwinch E, Edwards PR. Prospective randomized double-blind placebo-controlled cholangiopancreatography-induced pancreatitis. Br J Surg 2001; 88: 1178-82.

21. Moreto M, Zaballa M, Casado I, Merino O, Rueda M, Ramirez Z, Urcelay R, Baranda A. Trasdermal glyceril tinitrate in endoscopic retrograde cholangiopancreatography-induced pancreatitis. Br J Surg 2001; 88: 1182-1778.

22. Deviere J, Le Moine O, Van Laethem JL, Eisendrath P, Ghilain A, Severs N, Cohard M. Interleukin-10 reduce the incidence of pancreatitis after therapeutic endoscopic retrograde cholangiopancreatography. Gastroenterology 2001; 120: 498-505.

23. Dumont JA, Darwin CL, Zuccaro G, Vargo JJ, Shay SS, Kirk A. Interleukin 10 for the prevention of ERCP-induced pancreatitis. Am J Gastroenterol 2001; 96: 2098-2102.

24. Rabenstein T, Roggenbuck S, Framke B, Martus P, Fischer B, Nusko G, Muehidorfer S, Hochberger J, Ell C, Hahn EG, Schneider HT. Complications of endoscopic sphincterotomy: Can heparin prevent acute pancreatitis after ERCP? Gastrointest Endosc 2002; 55: 476-83.

25. Gross V, Lester HG, Heinisch A, Sholmerich J. Inflammatory mediators and cytokines: new aspects of the pathophysiology and assessment of severity of acute pancreatitis? Hepatogastroenterology 1993; 40: 522-30.

26. Ebbehoj N, Friis, Svendsen LB, Vulgo S, Madsen P. Indomethacin treatment of acute pancreatitis. A controlled double-blind trial. Sand J Gastroenterol 1985; 20: 798-800.