Evaluation of Pharmacologic Prevention of Pancreatitis After Endoscopic Retrograde Cholangiopancreatography: A Systematic Review

Kubiliun, Nisa; Adams, Megan A.; Akshintala, Venkata S.; Conte, Marisa; Coté, Gregory A.; Cotton, Peter B.; Dumonceau, Jean‐Marc; Elta, Grace H.; Fogel, Evan L.; Freeman, Martin L.; Lehman, Glen A.; Naveed, Mariam; Romagnuolo, Joseph; Scheiman, James M.; Sherman, Stuart; Singh, Vikesh K.; Elmunzer, B. Joseph

doi:10.1016/j.cgh.2014.11.038

Cited by 76 publications

(59 citation statements)

References 46 publications

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“…Despite medical condition enormously improved over the several decades, little progress has been made toward the goal of founding appropriate agents for preventing PEP (Kubiliun et al, 2015). SOM was firstly found potential for PEP in 1980s.…”

Section: Discussionmentioning

confidence: 99%

“…In the last three decades, extensive studies were made to investigate the solutions of reducing associated risk and increasing the safety (Choudhary et al, 2011; Dumonceau et al, 2014; Luo et al, 2016). It has demonstrated that the major therapy for PEP is pharmaco-prevention with different agents, such as somatostatin (SOM), non-steroidal anti-inflammatory drugs (NSAIDs), and indomethacin (Kubiliun et al, 2015). …”

Section: Introductionmentioning

confidence: 99%

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Role of Somatostatin in Preventing Post-endoscopic Retrograde Cholangiopancreatography (ERCP) Pancreatitis: An Update Meta-analysis

Zhang

et al. 2016

Front. Pharmacol.

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Background: Acute pancreatitis is the most common serious complication of endoscopic retrograde cholangiopancreatography (ERCP). Although, somatostatin (SOM) has been used in the prevention of post-ERCP pancreatitis (PEP), the efficacy of SOM remains inconsistent.Methods: Electronic databases, including PubMed/MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), and the Science Citation Index were searched to retrieve relevant studies. Details of the study population, including patients’ characteristics, sample size, regimen of drug administration and incidence of PEP, hyperamylasemia and abdominal pain were extracted by two investigators. Data were analyzed with Review Manager 5.3 software.Results: Eleven randomized controlled trials, enrolling a total of 4192 patients, were included in the meta-analysis. After data were pooled, we observed decreased incidence of ERCP-induced outcomes, such as PEP (RR = 0.63, 95% CI: 0.40, 0.98; P = 0.04) and hyperamylasemia (RR = 0.75, 95% CI: 0.66, 0.84; P < 0.001) in patients treated with SOM than those with placebo. Subgroup analysis by ethnicity found decreased incidence of PEP and hyperamylasemia in Asia only. Subgroup analysis by treatment schedule and dosage revealed decreased incidence of PEP and hyperamylasemia when SOM were treated with a single bolus or long-term infusion, or at dose above 3000 μg. We did not observed efficacy of SOM on abdominal pain in pooled or subgroup analysis.Conclusion: This meta-analysis of patients undergoing ERCP showed reduced incidence of PEP and hyperamylasemia when SOM was administrated with single bolus, long-term infusion, or high dosage. More data are needed to confirm our findings.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Role of Somatostatin in Preventing Post-endoscopic Retrograde Cholangiopancreatography (ERCP) Pancreatitis: An Update Meta-analysis

Zhang

et al. 2016

Front. Pharmacol.

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“…Additionally, topical epinephrine, aggressive intravenous administration of lactated Ringer's solution, gabexate, ulinastatin, secretin, and antibiotics were considered appropriate for additional exploratory research before confirmatory RCTs. 43 A complete review of the data surrounding Elmunzer these agents is beyond the scope of this article, but a few additional points are worth considering:…”

Section: Can Rectal Nonsteroidal Anti-inflammatory Drugs Replace Propmentioning

confidence: 99%

Preventing Postendoscopic Retrograde Cholangiopancreatography Pancreatitis

Elmunzer

2015

Gastrointestinal Endoscopy Clinics of North America

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“…The most recent meta-analyses and RCTs have demonstrated that allopurinol 102 , corticosteroids 103– 105 , somatostatin and their analogues 106 , heparin 107 , and nitroglycerin 86, 108 have an inconclusive or non-significant effect on reducing the risk of PEP. Whereas the protease inhibitor nafamostat reduces the risk of PEP 86, 109 , it does not reduce the risk of PEP in high-risk patients, has a high cost, and requires a prolonged 7- to 25-hour infusion that diminishes the practicality of offering this to patients 109 .…”

Section: Recent Advances In Early Treatment Of Acute Pancreatitismentioning

confidence: 99%

Recent advances in understanding and managing acute pancreatitis

Mandalia¹,

Wamsteker²,

DiMagno³

2018

F1000Res

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This review highlights advances made in recent years in the diagnosis and management of acute pancreatitis (AP). We focus on epidemiological, clinical, and management aspects of AP. Additionally, we discuss the role of using risk stratification tools to guide clinical decision making. The majority of patients suffer from mild AP, and only a subset develop moderately severe AP, defined as a pancreatic local complication, or severe AP, defined as persistent organ failure. In mild AP, management typically involves diagnostic evaluation and supportive care resulting usually in a short hospital length of stay (LOS). In severe AP, a multidisciplinary approach is warranted to minimize morbidity and mortality over the course of a protracted hospital LOS. Based on evidence from guideline recommendations, we discuss five treatment interventions, including intravenous fluid resuscitation, feeding, prophylactic antibiotics, probiotics, and timing of endoscopic retrograde cholangiopancreatography (ERCP) in acute biliary pancreatitis. This review also highlights the importance of preventive interventions to reduce hospital readmission or prevent pancreatitis, including alcohol and smoking cessation, same-admission cholecystectomy for acute biliary pancreatitis, and chemoprevention and fluid administration for post-ERCP pancreatitis. Our review aims to consolidate guideline recommendations and high-quality studies published in recent years to guide the management of AP and highlight areas in need of research.

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Evaluation of Pharmacologic Prevention of Pancreatitis After Endoscopic Retrograde Cholangiopancreatography: A Systematic Review

Cited by 76 publications

References 46 publications

Role of Somatostatin in Preventing Post-endoscopic Retrograde Cholangiopancreatography (ERCP) Pancreatitis: An Update Meta-analysis

Role of Somatostatin in Preventing Post-endoscopic Retrograde Cholangiopancreatography (ERCP) Pancreatitis: An Update Meta-analysis

Preventing Postendoscopic Retrograde Cholangiopancreatography Pancreatitis

Recent advances in understanding and managing acute pancreatitis

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