Efficacy of postprocedure administration of gabexate mesylate in the prevention of post-ERCP pancreatitis: a randomized, controlled, multicenter study

Protease inhibitors for preventing complications associated with ERCP: an updated meta-analysis

“…[37][38][39] Of the 28 articles, 18 met the inclusion criteria, [1][2][3][4][16][17][18][19][20][21][22][23][24][25][36][37][38][39] and no multiple publications were found. Agreement between reviewers regarding selection of relevant articles was 100%.…”

“…Acute pancreatitis was defined as upper abdominal pain with a serum amylase level in 11 studies, 1,3,4,17-19,22,36-39 upper abdominal pain with a serum amylase level of more than 3 times the upper limit of normal in 1 study, 24,25 upper abdominal pain with a serum amylase level of more than 5 times the upper limit of normal in 3 studies, 2,21,23 and persistent pain for at least 24 hours after ERCP with a serum amylase level higher than 500 U/L in 1 study. 37 The remaining 2 studies did not define acute pancreatitis.…”

Prevention of post-ERCP pancreatitis

“…However, while necrotizing pancreatitis was seen in 1 patient from the 1 st and 3 rd groups, it was not seen in the 2 nd group. The authors reported that since post-ERCP administration prevents PEP at the same rate as pre-ERCP administration, it would be more appropriate to identify the high-risk patients and to administer the drug on demand after ERCP (98). In a meta-analysis of six randomized controlled trials in 2000, GM significantly decreased PEP, hyperamylasemia and post-ERCP abdominal pain compared to control groups (p=0.001, p=0.007, p=0.005, respectively) (81).…”

Use of udenafil is not associated with a reduction in post-ERCP pancreatitis: results of a randomized, placebo-controlled, multicenter trial

“…All efforts to minimize the development of post-ERCP pancreatitis have been continued in several ways, and the following strategies for prevention of post-ERCP pancreatitis have been proposed: strict patient selection, 13 proper application of endoscopic technical maneuvers including placement of pancreatic stents, 14,15 wire-guided cannulation, 16 minimizing pancreatic injection, 17,18 and administration of prophylactic drugs. 2,3,8,[10][11][12][19][20][21] Abbreviations: CBD, common bile duct; PDE-5, phosphodiesterase type 5; NSAID, nonsteroidal anti-inflammatory drug; OR, odds ratio; SO, sphincter of Oddi; SOD, sphincter of Oddi dysfunction. …”

“…Pharmacological prevention of post-ERCP pancreatitis has focused on the interruption of several postulated mechanisms of injury: (1) relaxation of sphincter of Oddi (SO) and consequent promotion of pancreatic drainage by calcium channel antagonists 22 and nitroglycerin 2,12,19 ; (2) interruption of the inflammatory cascade by gabexate, 10 nafamostat, 3 and nonsteroidal anti-inflammatory drugs (NSAIDs) 11,23 ; and (3) inhibition of pancreatic secretion by somatostatin 20 and octreotide. 21 Clinical studies of pharmacological prevention have reported conflicting results.…”