Objective To evaluate the effectiveness and safety of gabexate mesylate in the prevention of post-endoscopic retrograde cholangiopancreatography （ERCP） pancreatitis （PEP）. Methods The literatures and corresponding references of randomized controlled trials （RCT） on gabexate mesylate in the prevention of PEP were searched from Cochrane library （1970 to December 2010），PubMed （1966 to December 2010），EMBASE （1966 to December 2010），and CBM （1978 to December 2010）.Literature screening，data extraction and methodological quality assessment were individually performed by two researchers.The software RevMan 4.2 of Cochrane Collaboration was used for statistical analysis. Results A total of 11 trails involving 3 012 patients were included. Meta analysis showed that high dose （≥1 000 mg）of gabexate mesylate with slow intravenous infusion （≥12 h） could effectively prevent from PEP （OR=0.27，95%CI： 0.11-0.64, P=0.003） and post-ERCP abdominal pain （OR=0.44，95%CI： 0.25-0.79，P=0.005） when compared with placebo. The low dose （≤500 mg） of gabexate mesylate with quick intravenous infusion （≤6.5 h） could not effectively prevent from PEP （OR=0.85, 95%CI： 0.59-1.34, P=0.570），post-ERCP hyperamylasemia （OR=0.86，95%CI： 0.69-1.07，P=0.180），and post-ERCP abdominal pain （OR=0.66，95%CI： 0.32-1.35，P=0.250）.When compared gabexate mesylate with ulinastatin, there was no statistical difference between them in the prevention of PEP （OR=1.57，95%CI： 0.39-6.24，P=0.520） and post-ERCP hyperamylasemia （OR=1.85, 95%CI： 0.83-4.13，P=0.130）. Conclusions The high dose （≥1 000 mg） of gabexate mesylate with slow intravenous infusion （≥12 h） other than low dose （≤500 mg） with quick intravenous infusion （≤6.5 h） is effective to prevent from PEP and post-ERCP abdominal pain，and can also prevent from post-ERCP hyperamylasemia to some extent.The effect which ulinastatin prevents PEP and post-ERCP hyperamylasemia is same to gabexate mesylate.The above conclusions remain to confirm by RCT with large sample and long-term follow-up of high-quality.
Objective To evaluate the effectiveness and safety of somatostatin and the analogue-octreotide in preventing post-ERCP pancreatitis. Methods We searched Cochrane Clinical Trial Register （Issue 1, April, 2004 ）, MEDLINE （1966- April, 2004）, EMBASE （1985- April, 2004）, CBM disc （1970- April, 2004） and The Clinical Trial Register of Chinese Evidence-Based Medicine Center and handsearched the related journals to identify Randomized Controlled Trials （RCT）of somatostatin and octreotide in post-endoscopic retrograde chnlangiopancreatography pancreatitis（PEP）prevention. Systematic review was conducted using the method recommended by The Cochrane Collaboration. Results Thirty-one trials involving 4 728 patients undergoing ERCP were included. Meta-analysis showed that the incidence of post-ERCP pancreatitis [ OR 0.33, 95% CI 0. 20 to 0. 54; P =0. 000 01 ; NNT =13] was significantly reduced by somatostatin. Octreotide could only reduce the incidence of hyperamylasemia [ OR 0. 54, 95% CI 0. 38 to 0. 77 ; P =0. 000 7 ]. The inci- dence of PEP, severe PEP and post-ERCP abdominal pain could not be reduced by octreotide. Conclusions Somatostatin can prevent post-ERCP pancreatitis. Four trials are of high quality in the 12 included studies and the results are consistent with the sensitive-analysis, so it is credible to some extent. However, existing evidence does not support that octreotide can reduce the incidence of PEP, so it is not recommended for this indication. Sensitive-analysis even showed that octreotide could increase the incidence of PEP. Therefore, whether it is necessary to carry out further clinical trials should be considered with caution.
Objective To explore the clinical application in the prevention of post-ERCP pancreatitis (PEP) for high-risk patients undergoing endoscopic duct stent placement. Methods The clinical data of 112 patients with high-risk PEP between January 2005 and June 2010 in this hospital were analyzed retrospectively. According to stents placement or not, 112 patients were divided into stent placement group (n=52) treated by ERCP and stents placement and non-stent placement group (n=60) treated by ERCP without stent retaining. PEP was diagnosed according to Cotton standard, the incidence rate of PEP was compared between two groups and the high-risk influencing factors were analyzed. Results According to Cotton standard, there were only 3 patients (5.8%) diagnosed PEP in the stent placement group, all symptoms disappeared on 48 h after operation, without a diagnosis for severe acute pancreatitis. There were 9 patients (15.0%) diagnosed PEP in the non-stent placement group, and 2 patients were severe acute pancreatitis, The status was better undergoing fasting, aprotinin, anti-inflammatory, and enteral nutrition supporting treatment. The incidence of PEP was associated with younger women (age ≤45 years), Oddi sphincter dysfunction, and no dilation of bile duct (Plt;0.05). Conclusion It can obviously reduce PEP occurrence in high-risk patients with stent placement.