Effects in the Control of Edema of the Papilla of Vater by Epinephrine Saline Irrigation after Endoscopic Retrograde Cholangiopancreatography in an Endoscopy Center in Japan, 2003 to 2007: Exploratory Retrospective Analysis to Evaluate the Characteristics of Eligible Patients with a Focus on Serum Amylase Levels

Abstract

Objective To evaluate the effects of localized irrigation with epinephrine saline after endoscopic retrograde cholangiopancreatography (ERCP). Patients and Methods

Prevention of post‐endoscopic retrograde cholangiopancreatography pancreatitis by epinephrine sprayed on the papilla

“…Endoscopic retrograde cholangiopancreatography is an endoscopic technique that has been applied since 1968 for imaging biliary and pancreatic ducts. Acute pancreatitis is the most frequent and serious complication of ERCP, which has plagued ERCP since its inception 6 …”

“…Acute pancreatitis is the most frequent and serious complication of ERCP, which has plagued ERCP since its inception. 6 Although various drugs (such as somatostatin, 7 Octreotide, 8 gabexate mesilate, 9,10 ulinastatin, 11 glyceryl trinitrate, 12 heparin, 13 and interleukin 10 14 ) have been used in an attempt to prevent PEP, most of these potentially beneficial drugs are costly, and/or require prolonged administration, 15 which would not be feasible for every patient undergoing ERCP. There are recent studies, which reported that the insertion of a guide wire into the biliary duct 16 and the placement of a stent in the pancreatic duct in high-risk patients 17 to be effective in preventing PEP.…”

Prevention of post-ERCP pancreatitis

“…Trials studying the effect of allopurinol on post-ERCP pancreatitis prevention have revealed conflicting results. 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] .…”

Rectal Indomethacin and Spraying of Duodenal Papilla With Epinephrine Increases Risk of Pancreatitis Following Endoscopic Retrograde Cholangiopancreatography

“…20 It may prevent PEP by decreasing the tissue edema around the PD orifice. 8,21 However, the possibly decreased blood supply after epinephrine spraying may inhibit the local concentration of indomethacin, thus antagonizing the beneficial effect of indomethacin. Second, counteraction between topical epinephrine and rectal indomethacin may exist.…”