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News

Clinical trial: allopurinol decreases post-endoscopic pancreatitis

Pretreatment with high-dose, orally administered allopurinol decreases the frequency of post-endoscopic retrograde cholangiopancreatography pancreatitis, finds this month's issue of Gastrointestinal Endoscopy.

News image

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Pancreatitis is the most common major complication of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography pancreatitis.

Allopurinol, a xanthine oxidase inhibitor that blocks generation of oxygen-derived free radicals, potentially may prevent post-endoscopic retrograde cholangiopancreatography pancreatitis pancreatitis.

Dr Kountouras and colleagues from Greece assessed the efficacy of high-dose oral allopurinol for prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis.

The researchers conducted a prospective, double-blind, placebo-controlled trial in 250 patients undergoing endoscopic retrograde cholangiopancreatography pancreatitis.

The team randomized patients to receive allopurinol (600 mg) or placebo orally at 15 and 3 hours before the procedure.

A total of 243 patients were included in the analysis.

Patients were clinically evaluated by the researchers, and serum amylase levels were determined before endoscopic retrograde cholangiopancreatography pancreatitis and at 6 and 24 hours thereafter.

The research team used standardized criteria to diagnose and to grade the severity of post-endoscopic retrograde cholangiopancreatography pancreatitis.

The investigators reported that the 2 groups were similar with regard to age; gender; underlying disease; indication for treatment; endoscopic retrograde cholangiopancreatography pancreatitis findings; and type of treatment, except for biliary sphincterotomy.

Only 43 patients in the allopurinol group underwent biliary sphincterotomy versus 87 in the placebo group.

The frequency of acute pancreatitis in the allopurinol group was 3% versus 18 % in the placebo group
Gastrointestinal Endoscopy

The team noted that the frequency of acute pancreatitis was significantly lower in the allopurinol versus the placebo group in the final multinomial regression analysis.

The research team found that the frequency of acute pancreatitis in the allopurinol group was 3%, with all 4 cases graded as mild.

The frequency of acute pancreatits in the placebo group was 18%, of which 8 cases were graded as mild, 11 as moderate, and 2 as severe with fatal outcome.

In addition, the researchers observed a protective effect of allopurinol in the diagnostic post-endoscopic retrograde cholangiopancreatography pancreatitis and the biliary sphincterotomy subgroups.

The frequency of post-endoscopic retrograde cholangiopancreatography pancreatitis was analyzed after stratification by procedure.

The mean duration of hospitalization for pancreatitis was significantly shorter in the allopurinol compared with the placebo group.

Dr Kountouras’ team concluded, “ Pretreatment with high-dose, orally administered allopurinol decreases the frequency of post-endoscopic retrograde cholangiopancreatography pancreatitis.”

“Despite the promising results of this prospective, randomized trial, further studies are needed to verify these observations before allopurinol can be recommended for routine clinical use.”

Gastrointest Endosc 2005: 61(3): 407
24 March 2005

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