A randomized controlled trial of pentoxifylline for the prevention of post-ERCP pancreatitis

Kapetanos, Dimitrios; Kokozidis, G.; Christodoulou, Dimitrios; Mistakidis, Konstantinos; Sigounas, Dimitrios E.; Dimakopoulos, Konstantinos; Kitis, G.; Tsianos, E.V.

doi:10.1016/j.gie.2007.03.1045

Cited by 30 publications

(27 citation statements)

References 40 publications

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“…Subsequent two meta-analyses of 10 RCTs (1554 patients and 1730 patients respectively) have concluded that allopurinol does not reduce post-ERCP pancreatitis and should be not recommended as a prophylactic agent [63,64] . Other agents studied (Adrenaline spray, pentoxifylline, platelet-activating factor acetylhidrolase, semapimod, aprepitant and risperidone) have either revealed discordant results or no effect on preventing post-ERCP pancreatitis [64][65][66][67][68][69][70][71][72][73] .…”

Section: Interruption Of Inflammatory Cascade (Anti-inflammatory): Nomentioning

confidence: 99%

Prevention of post-ERCP pancreatitis

Wong

Tsai

2014

WJGP

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Post-procedure pancreatitis is the most common complication of endoscopic retrograde cholangio pancreatography (ERCP) and carries a high morbidity and mortality occurring in at least 3%-5% of all procedures. We reviewed the available literature searching for "ERCP" and "pancreatitis" and "post-ERCP pancreatitis". in PubMed and Medline. This review looks at the diagnosis, risk factors, causes and methods of preventing post-procedure pancreatitis. These include the evidence for patient selection, endoscopic techniques and pharmacological prophylaxis of ERCP induced pancreatitis. Selecting the right patient for the procedure by a risk benefits assessment is the best way of avoiding unnecessary ERCPs. Risk is particularly high in young women with sphincter of Oddi dysfunction (SOD). Many of the trials reviewed have rather few numbers of subjects and hence difficult to appraise. Meta-analyses have helped screen for promising modalities of prophylaxis. At present, evidence is emerging that pancreatic stenting of patients with SOD and rectally administered nonsteroidal anti-inflammatory drugs in a large unselected trial reduce the risk of post-procedure pancreatitis. A recent meta-analysis have demonstrated that rectally administered indomethecin, just before or after ERCP is associated with significantly lower rate of pancreatitis compared with placebo [OR = 0.49 (0.34-0.71); P = 0.0002]. Number needed to treat was 20. It is likely that one of these prophylactic measures will begin to be increasingly practised in high risk groups.© 2014 Baishideng Publishing Group Co., Limited. All rights reserved. Key words: Acute pancreatitis; Endoscopic retrograde cholangio pancreatographyCore tip: Select patients carefully, and give high risk patients rectal indomethacin.Wong LL, Tsai HH. Prevention of post-ERCP pancreatitis.

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Section: Interruption Of Inflammatory Cascade (Anti-inflammatory): Nomentioning

confidence: 99%

Prevention of post-ERCP pancreatitis

Wong

Tsai

2014

WJGP

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“…The size of the RCT ranged from 40 to 701 (total 3,010). Among the 11 studies included here, all reported post-ERCP pancreatitis events [21-31], 8 reported mild and moderate post-ERCP pancreatitis events [22-26,28,29,31], and 6 reported severe post-ERCP pancreatitis events [22-24,26,28,29]. The median Jadad score of the studies included was 3 (range from 2 to 5).…”

Section: Resultsmentioning

confidence: 99%

“…The selected trials used different types of antioxidant, including sodium selenite [21], allopurinol [22,25,26,29-31], N-acetylcysteine [24,27], β-carotene [23], and pentoxifylline [28]. These antioxidants were administered orally or intravenously by different regimens and formulations.…”

Section: Resultsmentioning

confidence: 99%

Antioxidant supplementation for the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis: a meta-analysis of randomized controlled trials

Wei

Yin

2013

Nutr J

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BackgroundAcute pancreatitis remains the most common major complication of endoscopic retrograde cholangiopancreatography (ERCP). The pathogenesis of post-ERCP acute pancreatitis may be mediated by oxygen-derived free radicals, which could be ameliorated by antioxidants. Antioxidant supplementation may potentially prevent post-ERCP pancreatitis. We performed a meta-analysis of randomized controlled trials to evaluate the effect of prophylactic antioxidant supplementation compared with control on the prevention of post-ERCP pancreatitis.MethodsPubMed and Embase databases were searched to identify relevant trials. A standardized Excel file was used to extract data by two independent authors. Results were expressed as risk ratio (RR) with accompanying 95% confidence interval (CI). The meta-analysis was performed with the fixed-effects model or random-effects model according to heterogeneity.ResultsEleven studies involving 3,010 patients met our inclusion criteria. Antioxidant supplementation did not significantly decrease the incidence of post-ERCP pancreatitis (RR, 0.92; 95% CI, 0.65-1.32; P = 0.665). There was also no statistical difference in the severity grades between the antioxidant group and control group.ConclusionsBased on current evidence, antioxidant supplementation shows no beneficial effect on the incidence and the severity of post-ERCP pancreatitis; thus, there is currently a lack of evidence to support using antioxidants for the prevention of post-ERCP pancreatitis.

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“…Confirmatory results in larger controlled trials are awaited. Other pharmacological prevention trials evaluating pentoxifylline [5], somatostatin or gabexate [6], and intravenous nitroglycerin [7] were disappointing.…”

Section: Post-ercp Pancreatitis and Other Complicationsmentioning

confidence: 99%

ERCP topics

Cheon¹,

Fogel²

2006

Endoscopy

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IntroductionEndoscopic retrograde cholangiopancreatography (ERCP) has evolved significantly during the last two decades. While endoscopic management of biliary obstruction was initially hailed as a breakthrough, ERCP has developed tremendously and now offers a number of therapeutic applications. Although many endoscopists have expanded their armamentarium to include complex and controversial areas such as the management of pancreatitis, fluid collections, and sphincter of Oddi dysfunction (SOD), serious complications continue to occur. Numerous abstracts presented at this year's Digestive Disease Week (DDW) meeting addressed new techniques, while others focused on improving procedure safety. Selected abstracts are reviewed here. Post-ERCP pancreatitis and other complicationsPrevention of postprocedural complications was the focus of several abstracts this year. ERCP-induced pancreatitis continues to be a relevant clinical problem, despite technical advances and better understanding of predisposing factors. Identifying preprocedural risk factors may allow better case selection, excluding the highest-risk patients. The Indiana group examined the relationship between the extent of pancreatic duct filling and frequency of pancreatitis in 14 487 ERCPs [1]. Patients were divided into four groups according to the extent of pancreatic duct opacification: Group 1 (n = 6890) had no attempted opacification of the pancreatic duct; group 2, opacification of the head only; group 3, opacification of the head and body; group 4, opacification to the tail. The post-ERCP pancreatitis rates in each group were 1.0 %, 3.5 %, 4.6 %, and 8.5 %, respectively. There was a significantly higher incidence of pancreatitis with increased opacification of the pancreatic ductal system (P < 0.001), suggesting that less filling of the pancreatic duct was associated with less post-ERCP pancreatitis. It follows, therefore, that preprocedure magnetic resonance pancreatography may allow less pancreatic duct filling at ERCP, improving the safety of the procedure. Cost-benefit analyses, however, will be necessary to determine whether this strategy is a real option.Precut sphincterotomy to gain access to the common bile duct has been associated with a high risk of pancreatitis. In contrast, needle-knife sphincterotomy over a pancreatic stent has been shown to be safer than conventional pull-type sphincterotomy without a stent in patients with SOD. There have been no prospective studies comparing outcomes between the two techniques. A report from Alabama [2] prospectively compared the post-ERCP pancreatitis rate among high-risk patients undergoing two different endoscopic pancreatic sphincterotomy (EPS) techniques. Forty-eight patients diagnosed with pancreatic sphincter hypertension were randomly assigned to undergo EPS using a needle-knife over a pancreatic stent (n = 24) or with a pull-type sphincterotome followed by pancreatic stent (n = 24). The post-ERCP pancreatitis rate was significantly higher among patients undergoing EPS using the pull-type sph...

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A randomized controlled trial of pentoxifylline for the prevention of post-ERCP pancreatitis

Cited by 30 publications

References 40 publications

Prevention of post-ERCP pancreatitis

Prevention of post-ERCP pancreatitis

Antioxidant supplementation for the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis: a meta-analysis of randomized controlled trials

ERCP topics

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