Prophylaxis of ERCP-related pancreatitis: A randomized, controlled trial of somatostatin and gabexate mesylate1 1The trial was designed and the manuscript was written by Dr. Andriulli. No pharmaceutical or private grants were searched for or made available for performing the present work.

Andriulli, Angelo; Solmi, L.; Loperfido, Silvano; Leo, Pietro; Festa, V.; Belmonte, Angelo; Spirito, F.; Silla, Michele; Forte, Giovanna; Terruzzi, Vittorio; Marenco, G; Ciliberto, E.; Sabatino, Antonio Di; Monica, Fabio; Magnolia, M. R.; Perri, Francesco

doi:10.1016/s1542-3565(04)00295-2

Cited by 92 publications

(13 citation statements)

References 21 publications

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“…Prevention of PEP with gabexate has been the subject of several studies. Some have demonstrated that gabexate is effective in reducing the incidence of post-ERCP pancreatitis,1,14-16 yet others did not find any benefit in administering the drug 17,18. In the present study, the incidences of hyperamylasemia and acute pancreatitis in the gabexate group were 39.4% and 8.6%, respectively, which are similar or a little higher than other prospective studies 1,14,17,18.…”

Section: Discussioncontrasting

confidence: 49%

“…Some have demonstrated that gabexate is effective in reducing the incidence of post-ERCP pancreatitis,1,14-16 yet others did not find any benefit in administering the drug 17,18. In the present study, the incidences of hyperamylasemia and acute pancreatitis in the gabexate group were 39.4% and 8.6%, respectively, which are similar or a little higher than other prospective studies 1,14,17,18. Patient selection, indications for ERCP, therapeutic maneuvers performed, and different modalities of administering the drug are likely to explain the different results.…”

Section: Discussionmentioning

confidence: 99%

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Nafamostat for Prophylaxis against Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis Compared with Gabexate

Chang¹,

Lee²,

Kim³

et al. 2009

Gut Liver

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Background/AimsThe protease inhibitors, nafamostat and gabexate, have been used to prevent pancreatitis related to endoscopic retrograde cholangiopancreatography (ERCP). In vitro, nafamostat inhibits the pancreatic protease activities 10-100 times more potently than gabexate. We evaluated the efficacy of nafamostat for prophylaxis against post-ERCP pancreatitis in comparison with gabexate.MethodsFive hundred patients (208 patients in the nafamostat-treated group and 292 in the gabexate-treated group) were analyzed retrospectively after selective exclusion. The incidences of pancreatitis and hyperamylasemia after the ERCP were compared between the nafamostat and gabexate groups.ResultsThe incidences of acute pancreatitis and hyperamylasemia were 9.1% and 40.9%, respectively, in the nafamostat-treated group, and 8.6% and 39.4% in the gabexate-treated group. The frequencies of post-ERCP pancreatitis and hyperamylasemia did not differ significantly between the two groups, Post-ERCP pancreatitis in two group did not vary according to the different ERCP procedures. The mean serum amylase level at 6 h after ERCP was significantly lower in the nafamostat-treated group than in the gabexate-treated group (p=0.020). However, the difference in serum amylase level did not persist at 18 h and 36 h post-ERCP.ConclusionsAdministration of nafamostat before ERCP was not inferior to gabexate in protecting against the development of pancreatitis.

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Section: Discussioncontrasting

confidence: 49%

Section: Discussionmentioning

confidence: 99%

Nafamostat for Prophylaxis against Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis Compared with Gabexate

Chang¹,

Lee²,

Kim³

et al. 2009

Gut Liver

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“…The baseline characteristics of the 11 studies published between 1998 to 2015 are presented in Supplementary Table S1 (Bordas et al, 1998; Poon et al, 1999; Andriulli et al, 2002, 2004; Poon et al, 2003; Arvanitidis et al, 2004; Chan et al, 2008; Lee et al, 2008; Wang et al, 2013; Concepción-Martín et al, 2014; Bai et al, 2015). Totally, 4192 patients undergo ERCP procedures above average age of 58 years were analyzed.…”

Section: Resultsmentioning

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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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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“…Prevention of PEP with antiproteases, gabexate, or ulinastatin, has been evaluated in several studies. Some studies clearly demonstrated that gabexate mesylate or ulinastatin is effective in reducing the incidence of PEP,2,4,8,12,13 other studies did not find any benefit in administrating either drug 3,5,12. Compared with gabexate mesylate, ulinastatin has a stronger inhibitory effect on pancreatic enzymes in various experimental models of pancreatitis 14.…”

Section: Discussionmentioning

confidence: 99%

The Use of Gabexate Mesylate and Ulinastatin for the Prevention of Post- Endoscopic Retrograde Cholangiopancreatography Pancreatitis

Yoo¹,

Woo²,

Kim³

et al. 2012

Gut Liver

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Background/AimsAcute pancreatitis is a common complication of endoscopic retrograde cholangiopancreatography (ERCP). Only a few pharmacologic agents have been shown to have potential efficacy for the prophylactic treatment of post-ERCP pancreatitis (PEP). The aim of this study was to determine whether prophylactic gabexate and ulinastatin can decrease the incidence of PEP.MethodsFrom January 2005 to April 2010, 1,679 patients undergoing ERCP treatment were consecutively enrolled in the study. After selective exclusion, a total of 1,480 patients were included in the analysis. The patients were separated into 3 groups according to the prophylactic administration of gabexate (593 patients), ulinastatin (229 patients), or saline solution (658 patients) and analyzed retrospectively. The primary outcome measurements were the incidence of pancreatitis and hyperamylasemia.ResultsPEP occurred in 21 of the 593 (3.5%) patients who received gabexate, 16 of the 229 (7.0%) patients who received ulinastatin, and 48 of the 658 (7.3%) patients who received a saline solution. The incidence of PEP was significantly different between the gabexate and ulinastatin or saline solution groups (p<0.05).ConclusionsGabexate prophylaxis is effective in preventing PEP. However, there is no difference in the beneficial effects of the prophylactic administration of ulinastatin and a saline solution.

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Prophylaxis of ERCP-related pancreatitis: A randomized, controlled trial of somatostatin and gabexate mesylate1 1The trial was designed and the manuscript was written by Dr. Andriulli. No pharmaceutical or private grants were searched for or made available for performing the present work.

Cited by 92 publications

References 21 publications

Nafamostat for Prophylaxis against Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis Compared with Gabexate

Nafamostat for Prophylaxis against Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis Compared with Gabexate

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

The Use of Gabexate Mesylate and Ulinastatin for the Prevention of Post- Endoscopic Retrograde Cholangiopancreatography Pancreatitis

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