Original ArticleHigh-dose allopurinol for prevention of post-ERCP pancreatitis: a prospective randomized double-blind controlled trial
Section snippets
Patients
A double-blind, randomized, placebo-controlled trial was carried out with 250 consecutive patients undergoing diagnostic or therapeutic ERCP during a 16-month period (January 1999 to April 2000). Exclusion criteria were the following: (1) acute pancreatitis (patients undergoing early ERCP during the acute phase), (2) age less than 18 years, (3) history of allergy to allopurinol, (4) acute myocardial infarction within 3 months before ERCP, (5) other severe systemic disease, (6) pregnancy or
Results
Duodenal intubation was unsuccessful in 7 patients because of duodenal distortion (n = 1), a previous gastrectomy with Billroth II anastomosis (n = 4), or refusal to undergo ERCP (n = 2). These patients had been randomized to the placebo group and were excluded from analysis.
Multinomial regression by stepwise analysis revealed that the factors related to post-ERCP pancreatitis were male gender (p < 0.001), days of hospitalization (p < 0.001), in the sense that more days were required for the patients
Discussion
Although the exact mechanism(s) leading to post-ERCP pancreatic injury is unknown, there is great interest in pharmacologic treatment aimed at modulating the inflammatory mediators and activation of proteolytic enzymes thought to be involved in the development and the propagation of pancreatitis. Trials of prophylactic agents, including calcitonin,21 corticosteroid,9 glucagon,22 and nifedipine23 have failed to show benefit with respect to prevention of post-ERCP pancreatitis. A meta-analysis of
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2017, Mayo Clinic ProceedingsCitation Excerpt :Allopurinol, a xanthine oxidase inhibitor, is postulated to mediate this pathway, thus reducing the incidence of PEP. However, the early success of canine models84 did not translate into human studies, which had conflicting results.85-88 A pooled meta-analysis by Zheng et al,89 which included 6 RCTs totaling 1554 patients, evaluated the efficiency of allopurinol in the prevention of PEP.
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2016, Cell CalciumCitation Excerpt :Additionally, treatment of patients with an intravenous high dose vitamin C, which decreased oxidative stress markers in blood, caused a faster recovery from AP symptoms compared to low dose vitamin C and healthy control patients, although the fate of the severe AP patients was incompletely documented [87]. Time-dependent increases in ROS have been demonstrated in a preclinical study in rats in response to ductal ligation [88] and some benefit of antioxidant therapy in post-ERCP AP was reported in a prospective, double-blinded, placebo-controlled trial [89]; high dose allopurinol, applied prior to the surgical procedure, reduced AP incidence. Such a protective effect is therefore consistent with the efficacy of antioxidants in preclinical experimental AP models when administered as pre-treatments.
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