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

Abstract

Epinephrine sprayed on the papilla may be effective to prevent PEP. Female patients (aged ≥ 18 years and < 35 years) (7/40, 17.5%), common bile duct diameter < 10 mm (27/40, 67.5%), previous cholangitis (3/40, 7.5%), body mass index ≥ 24 (22/40, 55%), and/or serum triglycerides ≥ 5.65 mmol/L (6/40, 15%), might be risk factors for post-ERCP pancreatitis, but are not statistically significant in the study.

Systematic review with network meta‐analysis: pharmacological prophylaxis against post‐ERCP pancreatitis

“…There were two RCTs comparing topical epinephrine with placebo and these were conducted at different centres in Asia . The primary limitations of these studies were that they included only patients undergoing diagnostic ERCP and both utilised an ERCP protocol that mandates that a more experienced endoscopist complete difficult procedures.…”

“…The primary limitations of these studies were that they included only patients undergoing diagnostic ERCP and both utilised an ERCP protocol that mandates that a more experienced endoscopist complete difficult procedures. While patients undergoing diagnostic ERCP are typically considered to be at low risk for PEP, it should be noted that, in the epinephrine trial conducted by Xu et al ., 9% of the patients had acinarisation and the mean number of pancreatic duct contrast injections was 4.6. This suggests that many patients became high risk due to procedural interventions.…”

Prevention of post-ERCP pancreatitis

“…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

“…The results also showed no difference of overall PEP between the combined and indomethacinalone therapy (6.7% vs 6.4%), which was consistent with the findings of our study. Rectal indomethacin has been used increasingly since the publication of the study by Elmunzer et al 3 Although not reported, rectal indomethacin was less likely be administrated in patients in 2 well-conducted randomized controlled trials from Xu et al 6 and Matsushita et al 7 related to epinephrine spraying for PEP prevention, both of which were finished before 2011. All patients in the current study received rectal indomethacin before ERCP.…”

“…It may prevent PEP through direct relaxation of the sphincter of Oddi and reduction of papillary edema by decreasing capillary permeability, as shown in 2 randomized trials. 6,7 A meta-analysis suggested that papillary epinephrine spraying and rectal NSAIDs are the 2 most efficacious agents for PEP prevention. 8 We hypothesized that the combination of rectal indomethacin and papillary epinephrine spraying, which counteract the pathogenesis of PEP in different ways, may prevent PEP more vigorously.…”