ABSTRACT
BACKGROUND: Acute pancreatitis is a common complication of ERCP, occurring in up to 10% of cases. Chemoprevention of post-ERCP pancreatitis remains a debated issue. OBJECTIVE: This study evaluated whether increased dosage of octreotide, a potent inhibitor of pancreatic secretion, could reduce the incidence of post-ERCP pancreatitis. DESIGN: In a randomized, double-blind, placebo controlled trial, the effect of 500 microg octreotide, given 3 times daily subcutaneously starting 24 hours before the ERCP procedure, was compared with that of placebo in patients who underwent diagnostic and/or therapeutic ERCP. PATIENTS: A total of 202 patients were included in the trial. The 2 groups were similar in regards to age, sex, indications for treatment, underlying diseases, and types of therapeutic procedures. Patients were clinically evaluated, and serum amylase levels were determined before ERCP and at 6 to 8 hours thereafter. Standardized criteria were used to diagnose and to grade the severity of post-ERCP pancreatitis. RESULTS: The medication was discontinued because of an allergic reaction in 1 patient in the octreotide group. The incidence of post-ERCP pancreatitis was significantly lower in the octreotide group compared with the placebo group (2/10 [2%] vs 9/101 [8.9%], P = .03). All cases of acute pancreatitis were mild, except 2 (1 moderate and 1 severe) in the placebo group. CONCLUSIONS: The results of this trial support the use of 24-hour prophylaxis with high dose of octreotide in the prevention of post-ERCP pancreatitis.
Subject(s)
Cholangiopancreatography, Endoscopic Retrograde/adverse effects , Gastrointestinal Agents/administration & dosage , Octreotide/administration & dosage , Pancreatitis, Acute Necrotizing/etiology , Pancreatitis, Acute Necrotizing/prevention & control , Aged , Aged, 80 and over , Amylases/blood , Biomarkers/blood , Cholangitis/surgery , Colic/surgery , Dose-Response Relationship, Drug , Double-Blind Method , Drug Administration Schedule , Female , Gallstones/surgery , Humans , Incidence , Jaundice, Obstructive/surgery , Male , Middle Aged , Pancreatic Neoplasms/surgery , Pancreatitis, Acute Necrotizing/epidemiology , Pancreatitis, Acute Necrotizing/surgery , Recurrence , Severity of Illness Index , Treatment OutcomeABSTRACT
AIM: To compare the causes and clinical outcome of patients with acute upper gastrointestinal bleeding (AUGB) and a history of gastric surgery to those with AUGB but without a history of gastric surgery in the past. METHODS: The causes and clinical outcome were compared between 105 patients with AUGB and a history of gastric surgery, and 608 patients with AUGB but without a history of gastric surgery. RESULTS: Patients who underwent gastric surgery in the past were older (mean age: 68.1+/-11.7 years vs 62.8+/-17.8 years, P = 0.001), and the most common cause of bleeding was marginal ulcer in 63 patients (60%). No identifiable source of bleeding could be found in 22 patients (20.9%) compared to 42/608 (6.9%) in patients without a history of gastric surgery (P = 0.003). Endoscopic hemostasis was permanently successful in 26 out of 35 patients (74.3%) with peptic ulcers and active bleeding or non-bleeding visible vessel. Nine patients (8.6%) were operated due to continuing or recurrent bleeding, compared to 23/608 (3.8%) in the group of patients without gastric surgery in the past (P = 0.028). Especially in peptic ulcer bleeding patients, emergency surgery was more common in the group of patients with gastric surgery in the past (9/73 (12.3%) vs 19/360 (5.3%), P = 0.025). Moreover surgically treated patients in the past required more blood transfusion (3.3+/-4.0 vs 1.5+/-1.7, P = 0.0001) and longer hospitalization time (8.6+/-4.0 vs 6.9+/-4.9 d, P = 0.001) than patients without a history of gastric surgery. Mortality was not different between the two groups (4/105 (3.8%) vs 19/608 (3.1%)). CONCLUSION: Upper gastrointestinal bleeding seems to be more severe in surgically treated patients than in non-operated patients.
