Endoscopic retrograde cholangiopancreatography associated pancreatitis: A 15-year review

Table 7 Randomized controlled trails of pharmacologic agents evaluated for reduction or prevention of post-ERCP pancreatitis

				Rate of post-ERCP pancreatitis (%)
Agent	Author	Factor studied	n	Overall	Control	Intervention	P value
Allopurinol
	Martinez–Torres[110]	Allopurinol 300 mg PO at 15 h; 300 mg PO at 3 h before ERCP	170	NRa	9.40	2.30	0.049
	Romagnuolo[111]b	Allopurinol 300 mg PO at 1 h before ERCP	586	NRa	4.10	5.50	0.440
	Katsinelos[112]	Allopurinol 600 mg PO at 15 h; 600 mg PO at 3 h before ERCP	243	10.20	17.80	3.20	< 0.001
	Mosler[113]	Allopurinol 600 mg PO at 4 h; 300 mg PO at 1 h before ERCP	346	12.55	12.14	12.96	0.520
	Budzynska[114]	Allopurinol 200 mg PO at 15 h; 200 mg PO at 3 h before ERCP	300	10.70	7.90	12.10	0.320
Beta-carotene
	Lavy[115]	Natural beta-carotene 2 g at 12 h before ERCP	321	9.60	9.60	10.00	NRa
Botulinum toxin
	Gorelick[116]	Botulinum toxin injection after biliary sphincterotomy	26	NRa	43.00	25.00	0.340
Cephtazidime
	Raty[117]	Cephtazidime 2g IV 30 min before ERCP	321	NRa	9.38	2.58	0.009
Hydrocortisone
	Kwanngern[118]	Hydrocortisone 100 mg IV at 1 h before ERCP	120	6.67	11.86	1.64	0.031
	Manolakopoulos[119]b	Hydrocortisone 100 mg IV at 30 min before ERCP	340	10.00	13.00	7.10	0.380
	De Palma[31]	Hydrocortisone 100 mg IV immediately before ERCP	529	5.30	4.90	5.70	NS
Prednisone
	Sherman[120]b	Prednisone 40 mg PO at 15 h and at 3 h before ERCP	1115	15.07	13.60	16.60	0.190
	Budzynska[114]	Prednisone 40 mg at 15 h; 40 mg at 3 h before ERCP		10.70	7.90	12.00	0.330
Methylprednisolone
	Dumot[43]	Methylprednisolone 125 mg IV immediately before ERCP	286	NRa	8.70	12.40	0.340
Heparin
	Barkay[42]	Unfractionated heparin 5000 IU SC 20-30 min before ERCP	106	NRa	7.40	7.80	NS
	Rabenstein[121]	Low molecular weight heparin Certoparin 3000 IU SC the day before ERCP	448	8.50	8.81	8.14	0.870
Interlukin-10
	Sherman[56]b	IL-10 8 μg/kg IV 15-30 min before ERCP	305	17.38	14.30	15.40	0.830
		IL-10 20 μg/kg IV 15-30 min before ERCP				22.00	0.140
	Deviere[14]	IL-10 4 μg/kg IV 30 min before ERCP	144	29.90	24.40	10.41	0.046
		IL-10 20 μg/kg IV 30 min before ERCP				6.81	0.017
	Dumot[55]	IL-10 8 μg/kg IV 15 min before ERCP	200	10.00	9.10	10.90	0.650
N-acetyl cystine
	Milewski[122]	NAC 600 mg IV BID × 2 d after ERCP	106	9.43	11.76	7.27	NS
	Katsinelos[123]	NAC 70 mg/kg 2 h before and 35 mg/kg 4 h intervals for 24 h after procedure	249	10.80	9.60	12.10	> 0.500
Nifedipine
	Prat[124]	Nifedipine 20 mg PO 3-6 h before ERCP	155	15.50	17.70	13.20	NS
	Sand[125]	Nifedipine 20 mg PO q 8 h the day of ERCP	166	3.61	4.00	4.00	NRa
Nitroglycerin
	Hao[126]	Glyceryl trinitrate 5 mg IV and 100 mg vitamin C 5 min before ERCP maneuvers	74	16.20	25.00	7.90	0.012
	Beauchant[127]b	Nitroglycerin bolus of 0.1 mg, then 35 g/kg/min IV for 6 h after ERCP	208	12.00	15.00	10.00	0.260
	Kaffes[128]	Transdermal glyceryl trinitrate patch (15 mg) precordial area 30-40 min before ERCP	318	NRa	7.40	7.70	NS
	Moreto[129]	Transdermal glyceryl trinitrate patch (15 mg) precordial area 30-40 min before ERCP	144	9.00	15.00	4.00	0.030
	Sudhindran[130]	Glyceryl trinitrate 2 mg SL 5 min before ERCP	186	13.00	18.00	8.00	< 0.050
Diclofenac
	Khoshbaten[131]	Diclofenac 100 mg PR immediately after ERCP	100	15.00	26.00	4.00	< 0.010
	Cheon[132]	Diclofenac 50 mg at 30-90 min before and at 4-6 h after ERCP	207	16.40	16.70	16.20	NS
	Murray[44]	Diclofenac 100 mg PR immediately after ERCP	220	11.00	15.45	6.36	0.049
Indomethacin
	Sotoudehmanesh[133]	Indomethacin 100 mg PR after ERCP	442	4.98	6.78	3.16	OR 0.4 (0.2 - 1.1)
Octreotide
	Kisli[134]	Octreotide 0.1 mg gtt 60 min before ERCP and continued during and after ERCP	120	NRa	11.49	15.15	NS
	Li[135]b	Octreotide 0.3 mg gtt 1 h before -6 h after ERCP; then 0.1 mg SC; 12 h later 0.1 mg SC	832	3.85	5.26	2.42	0.046
	Thomopoulos[136]	Octreotide 500 μg TID starting 24 h before ERCP	201	10.89	8.90	2.00	0.03
	Testoni[137]b	Octreotide 200 μg TID × 24 h before ERCP	114	NRa	14.30	12.00	NS
	Hardt[138]	Octreotide 200 μg SC the night before ERCP	94	NRa	NRa	NRa	NS
	Duvnjak[139]	Octreotide 0.5 mg SC 60 min before ERCP	209	NRa	9.52	3.85	NS
	Arvanitidis[140]	Octreotide 0.1 mg SC 30 min before; 8 h and 16 h after ERCP	73	10.95	11.11	10.81	NS
	Tulassay[45]b	Octreotide 0.1 mg SC 45 min after ERCP	1199	7.84	6.00	5.90	NS
	Arcidiacono[141]	Octreotide 0.1 mg SC 120 and 30 min before; 4 h after ERCP	151	6.62	NRa	NRa	NS
	Baldazzi[142]	Octreotide 0.1 mg SC 45 min before; 6 h after ERCP	100	NRa	NRa	NRa	NRa
	Testoni[143]	Octreotide 0.2 mg SC before ERCP	60	NRa	NRa	NRa	NS
	Testoni[34]	Octreotide 200 μg TID × 3 d before ERCP	60	NRa	NRa	NRa	NS
Gabexate
	Ueki[144]	Gabexate 600 mg IV 60-90 min before and 22 h after ERCP	68	2.90	NRa	2.90	NS
	Manes[145]b	Gabexate mesylate 500 mg within 1 h before ERCP	608	5.60	9.40	3.90	< 0.01
		Gabexate mesylate 500 mg within 1h after ERCP				3.40	< 0.01
	Xiong[146]	Gabexate 300 mg IV 30 min before gtt until 4 h after ERCP	200	6.70	10.50	3.10	0.04
	Fujishiro[151]b	Gabexate 900 mg/1500 mL gtt for 13 h beginning 1 h before ERCP	139	NRa	NRa	4.30	NS
	Andriulli[59]b	Gabexate 500 mg 30 min before gtt until 6 h after ERCP	1127	5.60	4.80	5.80	NS
	Masci[96]b	Gabexate 500 mg IV 30 min before gtt until 6.5 h after ERCP and 1 g IV for 13 h after ERCP	434	1.80	2.20	1.40	NS
	Andriulli[147]b	Gabexate 500 mg IV 30 min before and 2 h after ERCP	579	8.60	6.50	8.10	NS
	Cavallini[148]b	Gabexate 1 g IV 30-90 min before gtt until 12 h after ERCP	418	5.00	8.00	2.00	0.03
Nafamostat mesylate
	Choi[149]	Nafamostat mesylate 20 mg gtt 1 h before and for 24 h after ERCP	704	5.40	7.40	3.30	0.018
Ulinastatin
	Yoo[150]	Ulinastatin 100 000 U gtt after ERCP for 5.5 h	227	6.20	5.60	6.70	0.715
	Ueki[144]	Ulinastatin 150 000 units 60-90 min before & for 22 h after ERCP	68	2.90	2.90	2.90	NS
	Fujishiro[151]b	Ulinastatin 150 000 units 1 h before, during; 11 h after ERCP				6.50	NS
		Ulinastatin 50 000 units				8.50	NS
	Tsujino[152]b	Ulinastatin 150 000 U gtt 10 min before ERCP	406	5.17	7.40	2.90	0.041
Pentoxifylline
	Kapetanos[153]	Pentoxifylline 400 mg PO TID before ERCP	320	4.38	3.00	5.60	0.28
Recombinant PAF acetylhydrolase
	Sherman[154]b	Recombinant PAF acetylhydrolase (rPAF-AH) 1 mg/kg gtt < 1 h before ERCP	600	17.60	19.60	17.50	0.59
		Recombinant PAF acetylhydrolase (rPAF-AH) 5 mg/kg gtt < 1 h before ERCP				15.90	0.34
Semapimod
	van Westerloo[155]	Semapimod IV 50 mg/100 mL glucose gtt 1 h before ERCP	242	11.98	14.88	9.09	0.117
Somatostatin
	Lee[156]b	Somatostatin 3 mg in 500 mL NS gtt 12 h starting 30min before ERCP	391	6.65	9.60	3.60	0.02
	Andriulli[59]b	Somatostatin 750 μg IV 30 min before and continued for 6 h after ERCP				6.30	NS
	Arvanitidis[157]	Somatastatin 4 μg/kg gtt 12 h on identification of the papilla and before introduction of the catheter	372	NRa	9.80	1.70	< 0.05
		Somatostatin 3 mg gtt 12 h on identification of the papilla and before introduction of the catheter				1.70	< 0.05
	Poon[158]	Somatostatin 250 mg IV bolus immediately after ERCP	270	NRa	13.30	4.40	0.01
	Andriulli[147]b	Somatastatin 750 μg IV 30 min before and 2 h after ERCP				11.50	NS
	Poon[159]	Somatostatin 3 mg in 500 mL NS gtt for 12 h starting 30 min before ERCP	220	5.91	10.00	3.00	0.03
	Bordas[160]	Natural somatostatin 4 mg/kg IV on identification of the papilla and before introduction of the catheter	160	NRa	10.00	2.50	< 0.05
Topical spray on papilla
	Matsushita[15]	Epinephrine (10 mL of 0.02%) sprayed on papilla before cannulation	370	1.10	2.16	0.00	0.123
	Schwartz[161]	Lidocaine (10 mL of 1%) sprayed on the major papilla before cannulation	294	4.08	3.04	4.32	0.73

PEP: Post-ERCP pancreatitis; ERCP: Endoscopic retrograde cholangiopancreatography; IL-10: Ingerlukin-10; NAC: N-acetyl cystine; NS: Not significant;

^aNot reported/unable to acquire primary data from publication;

^bMulti-centered.