The Use of a Long-Acting Somatostatin Analogue (Octreotide) for Prophylaxis of Acute Pancreatitis after Endoscopic Sphincterotomy

Abstract

Acute pancreatitis is a serious complication of endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (EST). In addition, serum pancreatic enzymes increase without clinical symptoms in about 40-50% of patients undergoing these endoscopic procedures. We evaluated the potential of octreotide, a long-acting somatostatin analogue, to prevent these complications in patients who underwent EST for choledocholithiasis. 151 patients were randomly allocated to two groups (A and B). Group A was given 0.1 mg of octreotide subcutaneously 120 and 30 min before EST and four hours after; group B was given a placebo. Serum amylases (normal range 20-220 IU/l) were measured before premedication and 4, 24, and 48 hours after the end of endoscopy. After EST, the increase in the mean serum amylase was greater in the control group, but the difference was statistically significant only at the 48-hour measurement. There were five cases of acute pancreatitis in each group, with a trend (but not statistically significant) toward less severe pancreatitis in the treated group. In the control group, one patient with acute pancreatitis died. In conclusion, octreotide does not seem to prevent acute post-EST pancreatitis.

Use of the laparoscopic–endoscopic approach, the so-called “rendezvous” technique, in cholecystocholedocholithiasis

“…Hyperamylasemia was defined when there was an increase in serum amylase above the upper normal value (220 IU/L); leukocytosis was defined when the white cell count was >10,000 cells/ mm 3 [2,27]. Pancreatic-like pain was defined as a persistent epigastric pain, often radiating to the back [13].…”

Prevention of post-ERCP pancreatitis

“…Octreotide did not prevent PEP in any of these trials. In addition, PEP was seen more frequently in the treatment group (35% vs. 11%) (84)(85)(86)(87)(88). In a meta-analysis of 15 randomized controlled trials, PEP was seen in 92 of 1,320 patients (7%) in the control group and in 72 of 1,301 patients (5.5%) in the treatment group.…”

Pharmacological Prevention and Treatment of Acute Pancreatitis: Where Are We Now?

“…The results varied widely. Several studies have failed to show that somatostatin or octreotide have any benefi cial effect, even when the drug was given before ERCP and up to 20 h later [49][50][51][52][53][54][55] . In one study, there was even an increase in the incidence of pancreatitis, when octreotide was given prophylactically before a diagnostic ERCP [56] .…”