Original ArticlesNifedipine for prevention of post-ERCP pancreatitis: A prospective, double-blind randomized study☆
Section snippets
Patients and methods
Patients referred to our center for ERCP, with or without sphincterotomy, on an inpatient basis (hospitalized at least 24 hours) were eligible for enrollment in the study. Exclusion criteria were (1) presentation with acute pancreatitis or acute abdominal pain caused by chronic pancreatitis, (2) treatment with calcium channel inhibitors, (3) pregnancy or not using effective methods of contraception for women able to procreate, (4) mental impairment, (5) upper GI obstruction, (6) previous
Results
Of the total of 155 patients included in the study, 76 were randomized to the nifedipine group and 79 to the placebo group. One hundred twenty-nine patients (83.2%) completed the protocol and were eligible for per-protocol analysis. The remaining 26 patients (nifedipine 18, 16.8%; placebo 8, 10.1%; p = 0.02) received medication or placebo only once, either before or after ERCP, generally because blood pressure was lower than 80 mm Hg at the time scheduled for administration. Major patient
Discussion
Pancreatitis is the most frustrating complication of ERCP for two reasons: (1) Although certain risk factors have been clearly identified,1, 2, 3, 6, 7, 18 knowledge of these is not really helpful in avoiding pancreatitis in the individual patient; the development of pancreatitis remains unpredictable. This is confirmed in the present study by the finding that “difficult” ERCP was the most significant and the sole independent predictor of pancreatitis as well as persistent pain. The existence
References (22)
- et al.
Prophylactic effect of somatostatin on post-ERCP pancreatitis: a randomized controlled trial
Gastrointest Endosc
(1999) - et al.
Medical treatment can diminish pancreatic damages after ERCP: a metaanalysis
Gastrointest Endosc
(2000) - et al.
Does prophylactic oral steroid administration reduce the frequency and severity of post-ERCP pancreatitis? Randomized prospective multicenter study [abstract]
Gastrointest Endosc
(1997) - et al.
Use of corticosteroids in the prevention of post-ERCP pancreatitis: results of a controlled prospective study
Am J Gastroenterol
(1999) - et al.
Interleukin 10 reduces the incidence of pancreatitis after therapeutic endoscopic retrograde cholangiopancreatography
Gastroenterology
(2001) - et al.
Effect of nifedipine on sphincter of Oddi motor activity: studies in healthy volunteers and patients with biliary dyskinesia
Gastroenterology
(1988) - et al.
Endoscopic sphincterotomy complications and their management: an attempt at consensus
Gastrointest Endosc
(1991) - et al.
Same day discharge after endoscopic biliary sphincterotomy: observations from a prospective multicenter complication study
Gastrointest Endosc
(1999) Complications of endoscopy
Endoscopy
(1994)- et al.
Complications of endoscopic biliary sphincterotomy
N Engl J Med
(1996)
Complications of endoscopic sphincterotomy and their prevention
N Engl J Med
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2016, Clinical Gastroenterology and HepatologyCitation Excerpt :The combination of conflicting data regarding their efficacy, as well as the potential for serious side effects (such as hypotension), makes it difficult to recommend the routine use of nitrates for the prevention of PEP.33 Systemic nifedipine, a dihydropyridine thought to promote papillary relaxation through its action on L-type calcium channels, was ineffective in 2 controlled trials.34,35 Similarly, neither lidocaine24 nor epinephrine25 have been shown to be effective in preventing PEP when sprayed topically on the major papilla.
Incidence, severity, and mortality of post-ERCP pancreatitis: A systematic review by using randomized, controlled trials
2015, Gastrointestinal EndoscopyEndoscopic Retrograde Cholangiopancreatography (ERCP)-Related Adverse Events: Post-ERCP Pancreatitis
2015, Gastrointestinal Endoscopy Clinics of North AmericaCitation Excerpt :Chemoprophylaxis of PEP has also been suggested and extensively researched in an attempt to prevent or reduce the severity of PEP. Five main targets for chemoprevention include: prevention of intra-acinar trypsinogen activation (protease inhibitors such as gabexate, ulinastatin, nafamostat mesylate)48; reduction of pancreatic enzyme secretion (somatostatin and octreotide)49,50; relaxation of sphincter of Oddi spasm (nitroglycerin, nifedipine, phosphodiesterase-5 inhibitors)51–53; interruption of the inflammatory cascade (nonsteroidal anti-inflammatory drugs [NSAIDs], interleukin-10, corticosteroids, allopurinol, heparin, N-acetylcysteine)54–60; and prevention of infection (antibiotics).61 However, numerous trials studying a variety of such pharmacologic agents have yielded disappointing or conflicting results; with the important exception of rectal administration of NSAIDs, which have been shown in several randomized controlled trials and meta-analyses to significantly reduce the incidence and severity of PEP.54–56,62–66
Combination Topical Epinephrine and Non-steroidal Inflammatory Drugs in the Prevention of Post-ERCP Pancreatitis: A Systematic Review
2023, Digestive Diseases and Sciences
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Reprint requests: F. Prat, MD, Service des Maladies du Foie et de l'Apareil Digestif, CHU de Bicêtre, 78, rue de Général Leclerc, 94275 Le Kremlin-Bicêtre Cedex, France.