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Pharmacologic prophylaxis of post-ERCP pancreatitis

The most recent issue of the Journal of Gastroenterology evaluates the use of protease inhibitors and NSAIDs for the prophylaxis of post-endoscopic retrograde cholangiopancreatography pancreatitis.

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Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis is the most frequent complication of ERCP.

Several meta-analyses have examined the effects of protease inhibitors (gabexate mesilate, ulinastatin, and nafamostat mesilate) and non-steroidal anti-inflammatory drugs (NSAIDs) on post-ERCP pancreatitis, but the results have been confusing.

Since the previous meta-analysis, several new studies have been published on this topic.

Dr Hiroki Yuhara and colleagues from Japan provided an updated quantitative assessment of the effectiveness of protease inhibitors and NSAIDs in preventing post-ERCP pancreatitis.

NSAIDs were associated with decreased risk of post-ERCP pancreatitis
Journal of Gastroenterology

The research team conducted a meta-analysis of randomized trials for patients at risk of post-ERCP pancreatitis.

The team included 26 articles in this meta-analysis.

Nafamostat mesilate and NSAIDs were associated with decreased risk of post-ERCP pancreatitis in the high-quality studies.

However, the researchers found that gabexate mesilate, and ulinastatin were not associated with decreased risk of post-ERCP pancreatitis in the high-quality studies.

Dr Yuhara and team comment, "This is the first meta-analysis to compare the effects of 3 protease inhibitors."

"Solid evidence supports the use of nafamostat mesilate and NSAIDs for preventing post-ERCP pancreatitis."

J Gastroenterol 2014; 49(3): 388-99
04 April 2014

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