Document Detail

Prophylactic administration of somatostatin or gabexate does not prevent pancreatitis after ERCP: an updated meta-analysis.
MedLine Citation:
PMID:  17383459     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The prophylactic use of somatostatin or gabexate in patients undergoing ERCP is still controversial. OBJECTIVE: Our purpose was to update the meta-analysis on somatostatin (SS, 16 studies) or gabexate mesylate (GM, 9 studies) prophylaxis of post-ERCP pancreatitis and to run sensitivity analyses by subgrouping trials according to schedules of drug administration. MAIN OUTCOME MEASUREMENTS: Post-ERCP acute pancreatitis, hyperamylasemia, and pain. RESULTS: Heterogeneity was present among selected studies, which appeared eliminated when only 9 high-quality trials on SS and 5 randomized studies on GM were considered. After data were pooled from SS trials, pancreatitis occurred in 7.3% of controls versus 5.3% of treated patients, a nonsignificant effect (odds ratio [OR] = 0.73; 95% CI 0.54-1.006). The funnel plot showed asymmetry with a negative slope (P = .05). The meta-analysis produced negative results for either short- (<6 hours) or long-term (> or =12 hours) SS infusion, whereas a bolus injection proved effective (OR = 0.271; 95% CI 0.138-0.536), with a pooled absolute risk reduction of 8.2% (95% CI 4.4-12.0%). Postprocedural hyperamylasemia, but not pain, was significantly reduced (OR = 0.67, 95% CI 0.57-0.81). In controls and patients treated with GM, pancreatitis developed in 5.7% versus 4.8%, hyperamylasemia in 40.6% versus 36.9%, and pain in 1.7% versus 8.9%. All pooled ORs were nonsignificant: P = .34, .17, and .19, respectively. The meta-analysis produced no significant effect for either short-term (<6 hours) or long-term (>12 hours) GM administration. CONCLUSION: Short- or long-term infusion of SS or GM proved ineffective in reducing post-ERCP pancreatitis and pain. The beneficial effect of SS on postprocedural hyperamylasemia seems of marginal significance. When given as a bolus injection, SS maintains its promise in this field, but additional data are needed.
Angelo Andriulli; Gioacchino Leandro; Telemaco Federici; Antonio Ippolito; Rosario Forlano; Angelo Iacobellis; Vito Annese
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Publication Detail:
Type:  Journal Article; Meta-Analysis    
Journal Detail:
Title:  Gastrointestinal endoscopy     Volume:  65     ISSN:  0016-5107     ISO Abbreviation:  Gastrointest. Endosc.     Publication Date:  2007 Apr 
Date Detail:
Created Date:  2007-03-26     Completed Date:  2007-09-20     Revised Date:  2008-02-26    
Medline Journal Info:
Nlm Unique ID:  0010505     Medline TA:  Gastrointest Endosc     Country:  United States    
Other Details:
Languages:  eng     Pagination:  624-32     Citation Subset:  IM    
Division of Gastroenterology, Casa Sollievo Sofferenza and De Bellis Hospitals, Istituto di Ricovero e Cura a Carattere Scientifico, San Giovanni Rotondo, Italy.
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MeSH Terms
Cholangiopancreatography, Endoscopic Retrograde / adverse effects*
Gabexate / therapeutic use*
Hormones / therapeutic use*
Pancreatitis / etiology*,  prevention & control*
Serine Proteinase Inhibitors / therapeutic use*
Somatostatin / therapeutic use*
Reg. No./Substance:
0/Hormones; 0/Serine Proteinase Inhibitors; 39492-01-8/Gabexate; 51110-01-1/Somatostatin
Comment In:
Gastrointest Endosc. 2008 Jan;67(1):190; author reply 190-1   [PMID:  18155442 ]
Nat Clin Pract Gastroenterol Hepatol. 2008 Jan;5(1):14-5   [PMID:  17998925 ]

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