Is prophylactic somatostatin effective to prevent post-endoscopic retrograde cholangiopancreatography pancreatitis or hyperamylasemia？ A randomized, placebo-controlled pilot trial

Background Effects of prophylactic somatostatin on post-endoscopic retrograde cholangiopancreatography （ERCP） pancreatitis （PEP） and hyperamylasemia remain inconclusive. This study aimed to examine whether high-dose, long-term continuous infusion of somatostatin can reduce the incidence of PEP and p...

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Published in:Chinese medical journal 2013-07, Vol.126 (13), p.2403-2408
Main Authors: Wang, Zi-kai, Yang, Yun-sheng, Cai, Feng-chun, Wang, Yong-hua, Shi, Xiao-lin, Ding, Chen, Li, Wen
Format: Article
Language:English
Subjects:
Adult
Aged
Cholangiopancreatography, Endoscopic Retrograde - adverse effects
Female
Humans
Hyperamylasemia - prevention & control
Male
Middle Aged
Pancreatitis - prevention & control
Pilot Projects
Somatostatin - therapeutic use
生长抑素
胆管
胰腺炎
血清淀粉酶
血症
试验计划
造影
预防性
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Summary:Background Effects of prophylactic somatostatin on post-endoscopic retrograde cholangiopancreatography （ERCP） pancreatitis （PEP） and hyperamylasemia remain inconclusive. This study aimed to examine whether high-dose, long-term continuous infusion of somatostatin can reduce the incidence of PEP and post-ERCP hyperamylasemia. Methods This was a randomized, placebo-controlled pilot trial. One hundred and twenty-four patients scheduled for ERCP from December 2008 to May 2010 randomly received one of the following three interventions： pre-ERCP somatostatin （0.5 mg/h for 24 hours, starting 1 hour prior to ERCP; n=36）, post-ERCP somatostatin （0.5 mg/h for 24 hours, starting 1 hour after ERCP; n=47）, or placebo （saline for 24 hours, starting 1 hour prior to ERCP; n=41）. Serum amylase and lipase concentrations were measured 1 to 3 hours prior to ERCP and 6, 24, and 48 hours after ERCP. Results The three groups did not differ in age, gender, medical history, or ERCP procedure （catheterization using contrast or guidewire, pancreatic duct visualization, procedure time, or procedure type）. The rate of PEP was 13.7% （17/124） in the overall study sample and 16.7% （6/36）, 10.6% （5/47）, and 14.6% （6/41） in the pre-ERCP somatostatin, post- ERCP somatostatin, and placebo groups, respectively （P=0.715）. The rate of post-ERCP hyperamylasemia was 19.4% （7/36）, 21.3% （10/47）, and 46.3% （19/41） in the pre-ERCP somatostatin, post-ERCP somatostatin, and placebo groups, respectively （P=0.011）. Conclusions High-dose, long-term continuous infusion （0.5 mg/h for 24 hours） of somatostatin, performed as either a pre- or post-ERCP, can reduce the incidence of hyperamylasemia, but not PEP.
ISSN:0366-6999
2542-5641
DOI:10.3760/cma.j.issn.0366-6999.20130261