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News

Gabexate and somatostatin do not protect against post-ERCP pancreatitis

Short-term administration of gabexate or somatostatin in patients at high risk for pancreatitis is ineffective for the prevention of ERCP-induced pancreatitis, claim researchers from Italy.

News image

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The team investigated the use of somatostatin or gabexate for prevention of post-ERCP pancreatitis, and reported the findings in the October issue of Gastrointestinal Endoscopy.

They conducted a trial in patients at high risk for post-ERCP pancreatitis.

Individuals were randomized to receive an intravenous infusion of somatostatin (750 mg), gabexate (500 mg), or placebo.

The infusion was started 30 minutes before endoscopy and continued for 2 hours afterwards.

Patients were evaluated clinically. Serum amylase levels were determined at 4 and 24 hours after endoscopy.

No significant difference in the occurrence of pancreatitis, hyperamylasemia, or abdominal pain was observed among placebo-, gabexate-, and somatostatin-treated patients.

Post-ERCP pancreatitis predictors:
- Sphincterotomy > 2 cm
- > 3 pancreatic injections
- Unsuccessful cannulation
Gastrointestinal Endoscopy

The researchers found that a sphincterotomy longer than 2 cm, more than 3 pancreatic injections, and unsuccessful cannulation were predictive of post-ERCP pancreatitis.

In addition, hyperamylasemia was predicted by more than 3 pancreatic injections and sphincterotomy.

The team also conducted a meta-analysis of all published studies on the use of somatostatin or gabexate for prevention of post-ERCP pancreatitis.

From this, short-term infusions of either drug were not found to be efficacious.

Dr Angelo Andriulli, of the Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, said on behalf of fellow authors, "Short-term administration of gabexate or somatostatin in patients at high risk for pancreatitis is ineffective for prevention of ERCP-induced pancreatitis."

"Pancreatic injury is related to maneuvers used to obtain biliary access rather than to any patient characteristic or endoscopist experience," it was concluded.

Gastrointest Endosc 2002; 56: 488-95
02 October 2002

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