Abstract
Background
Epinephrine sprayed on the papilla may reduce papillary edema and thus prevent acute pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP). The aim of this study was to determine the efficacy of this technique for prevention of post- ERCP pancreatitis.
Methods
Patients scheduled for ERCP were recruited into this study. We randomized the patients to have 10 ml of either 0.02% epinephrine (epinephrine group) or saline (control group) sprayed on the papilla after diagnostic ERCP and prospectively analyzed the occurrence of post-ERCP pancreatitis between the groups. We recorded duct visualization, presence of pancreatic acinarization, number of injections into the pancreatic duct, total volume of contrast used, and procedure duration.
Results
There was no significant difference between the groups with regard to visualization of the bile duct and/or the main and accessory pancreatic ducts, presence of pancreatic acinarization, number of injections into the pancreatic duct, total volume of contrast used, and procedure duration. Overall, post-ERCP pancreatitis occurred in 4 of the 370 patients (1.1%). The incidence of pancreatitis tended to be higher in the control group (4/185) than in the epinephrine group (0/185) (P = 0.1230).
Conclusions
Epinephrine sprayed on the papilla tended to prevent post-ERCP pancreatitis, although it was not statistically significant because of the low incidence of pancreatitis. Further studies on the efficacy of this technique in patients at high risk for pancreatitis, and on other volumes and/or concentrations of epinephrine, are warranted.
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References
Kemppainen E, Hedström J, Puolakkainen P, Halttunen J, Sainio V, Haapiainen R, et al. Increased serum trypsinogen 2 and trypsin 2-α1 antitrypsin complex values identify endoscopic retrograde cholangiopancreatography induced pancreatitis with high accuracy. Gut 1997;41:690–695.
Johnson GK, Geenen JE, Johanson JF, Shermal S, Hogan WJ, Cass O (Midwest Pancreaticobiliary Study Group). Evaluation of post-ERCP pancreatitis: potential causes noted during controlled study of differing contrast media. Gastrointest Endosc 1997;46:217–222.
Tarnasky P, Cunningham J, Cotton P, Hoffman B, Palesch Y, Freeman J, et al. Pancreatic sphincter hypertension increases the risk of post-ERCP pancreatitis. Endoscopy 1997;29:252–257.
Ohashi A, Tamada K, Tomiyama T, Wada S, Higashizawa T, Gotoh Y, et al. Epinephrine irrigation for the prevention of pancreatic damage after endoscopic balloon sphincteroplasty. J Gastroenterol Hepatol 2001;16:568–571.
Schwartz JJ, Lew RJ, Ahmad NA, Shah JN, Ginsberg GG, Kochman ML, et al. The effect of lidocaine sprayed on the major duodenal papilla on the frequency of post-ERCP pancreatitis. Gastrointest Endosc 2004;59:179–184.
Wehrmann T, Schmitt T, Stergiou N, Capary WF, Seifert H. Topical application of nitrates onto the papilla of Vater: manometric and clinical results. Endoscopy 2001;33:323–328.
Ohno T, Katori M, Nishiyama K, Saigenji K. Direct observation of microcirculation of the basal region of rat gastric mucosa. J Gastroenterol 1995;30:557–564.
Igawa M, Miyaoka M, Saitoh T. Influence of topical epinephrine application on microcirculatory disturbance in subjects with ulcerative colitis evaluated by laser Doppler flowmetry and transmission electron microscopy. Dig Endosc 2000;12:126–130.
Panteghini M, Pagani F, Alebardi O, Lancini G, Cestari R. Time course of changes in pancreatic enzymes, isoenzymes, and isoforms in serum after endoscopic retrograde cholangiopancreatography. Clin Chem 1991;37:1602–1605.
Messmann H, Vogt W, Holstege A, Lock G, Heinisch A, von Furstenberg A, et al. Post-ERP pancreatitis as a model for cytokine induced acute phase response in acute pancreatitis. Gut 1997;40:80–85.
Cotton PB, Lehman G, Vennes J, Geenen JE, Russell RCG, Meyers WC, et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc 1991;37:383–393.
Fazel A, Quadri A, Catalano MF, Meyerson SM, Geenen JE. Does a pancreatic duct stent prevent post-ERCP pancreatitis? A prospective randomized study. Gastrointest Endosc 2003;57:291–294.
Freeman ML, Nelson DB, Sherman S, Haber GB, Herman ME, Dorsher PJ, et al. Complications of endoscopic biliary sphincterotomy. N Engl J Med 1996;335:909–918.
Devie’re J, Moine OL, Van Laethem JL, Eisendrath P, Ghilain A, Severs N, et al. Interleukin 10 reduces the incidence of pancreatitis after therapeutic endoscopic retrograde cholangiopancreatography. Gastroenterology 2001;120:498–505.
Murray B, Carter R, Imrie C, Evans S, O’suilleabhain C. Diclofenac reduces the incidence of acute pancreatitis after endoscopic retrograde cholangiopancreatography. Gastroenterology 2003;124:1786–1791.
Poon RTP, Yeung C, Liu CL, Lam CM, Yuen WK, Lo CM, et al. Intravenous bolus somatostatin after diagnostic cholangiopancreatography reduces the incidence of pancreatitis associated with therapeutic endoscopic retrograde cholangiopancreatography procedures: a randomized controlled trial. Gut 2003;52:1768–1773.
Cavallini G, Tittobello A, Frulloni L, Masci E, Mariani A, Francesco VD. Gabexate for the prevention of pancreatic damage related to endoscopic retrograde cholangiopancreatography. N Engl J Med 1996;335:919–923.
Tsujino T, Komatsu Y, Isayama H, Hirano K, Sasahira N, Yamamoto N, et al. Ulinastatine for pancreatitis after endoecopic retrograde cholangiopancreatography: a randomized, controlled trial. Clin Gastroenterol Hepatol 2005;3:376–383.
Moreto’ M, Zaballa M, Casado I, Merino O, Rueda M, Rami’rez K, et al. Transdermal glyceryl trinitrate for prevention of post-ERCP pancreatitis: a randomized double-blind trial. Gastrointest Endosc 2003;57:1–7.
Rabenstein T, Roggenbuck S, Framke B, Martus P, Fischer B, Nusko G, et al. Complications of endoscopic sphincterotomy: can heparin prevent acute pancreatitis after ERCP? Gastrointest Endosc 2002;55:476–483.
Mosler P, Sherman S, Marks J, Watkins JL, Geenen JE, Jamider P, et al. Oral allopurinol does not prevent the frequency or the severity of post-ERCP pancreatitis. Gastrointest Endosc 2005;62:245–250.
Nowak A, Nowakowska-Dutawa E, Rybicka J. Patency of the Santorini duct and acute biliary pancreatitis. A prospective ERCP study. Endoscopy 1990;22:124–126.
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Matsushita, M., Takakuwa, H., Shimeno, N. et al. Epinephrine sprayed on the papilla for prevention of post-ERCP pancreatitis. J Gastroenterol 44, 71–75 (2009). https://doi.org/10.1007/s00535-008-2272-8
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DOI: https://doi.org/10.1007/s00535-008-2272-8