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Octreotide in the prevention of pancreatic damage induced by endoscopic sphincterotomy
P D Hardt1, O Kress, T Fadgyas
1Med. Klinik III und Poliklinik der JLU Giessen, Rodthohl 6, D-35385 Giessen, Germany. Philip.D.Hardt@innere.med.uni-giessen.de
Abstract:
Somatostatin and the long acting analogue octreotide have been proposed as a therapeutic agent in acute pancreatitis and for the prophylaxis of pancreatic damage by ERCP and EST for their ability to reduce exocrine pancreatic secretion. However, clinical trials could not show significant beneficial effects in acute pancreatitis and ERCP. In patients undergoing EST, data remained controversial, most authors describing positive effects of prophylaxis. In this study we investigated the use of octreotide prophylaxis to reduce EST-induced pancreatic damage in a randomised, double blind trial. 94 consecutive ERCP/EST-patients were randomised to receive either octreotide 200 microgram s.c. or placebo 3 times daily, starting the night before endoscopic procedures. In 59 patients EST was performed. Blood samples were collected before and 40 min, 2 hrs, 6 hrs, 24 hrs, 48 hrs and 72 hrs after the endoscopic procedures. Samples were analysed for pancreatic serum enzymes, acute phase proteins and blood counts. A clinical pain score was investigated. Post-EST-pancreatitis (amylase > 3x upper limit and persistent abdominal pain) was diagnosed in 3 patients in the treatment group, in 4 patients in the placebo group. There were no significant differences in the time-courses of serum enzymes or acute phase proteins in-between the groups, nor in the pain-score. According to these data, prophylactic octreotide application does not prevent acute pancreatic damage induced by endoscopic sphincterotomy.
Insights
Octreotide, a somatostatin analogue, was investigated for preventing pancreatic damage after endoscopic sphincterotomy (EST). This study found that prophylactic octreotide did not significantly reduce the incidence of post-EST pancreatitis or associated symptoms.
Area of Science:
- Gastroenterology
- Endocrinology
- Clinical Pharmacology
Background:
- Somatostatin and octreotide have been explored for reducing exocrine pancreatic secretion, potentially aiding in acute pancreatitis and preventing pancreatic damage during endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (EST).
- Previous clinical trials showed limited benefits for acute pancreatitis and ERCP, with controversial findings regarding EST prophylaxis.
Purpose of the Study:
- To investigate the efficacy of octreotide prophylaxis in reducing pancreatic damage induced by endoscopic sphincterotomy (EST).
Main Methods:
- A randomized, double-blind trial involving 94 patients undergoing ERCP/EST.
- Patients received either octreotide (200 microgram s.c. three times daily) or placebo, starting the night before the procedure.
- Pancreatic serum enzymes, acute phase proteins, blood counts, and a clinical pain score were monitored post-EST in 59 patients.
Main Results:
- Post-EST pancreatitis occurred in 3 patients in the octreotide group and 4 in the placebo group, with no significant difference.
- No significant differences were observed in the time-course of serum enzymes, acute phase proteins, or pain scores between the treatment and placebo groups.
Conclusions:
- Prophylactic octreotide administration does not effectively prevent acute pancreatic damage following endoscopic sphincterotomy.
- Further research may be needed to explore alternative prophylactic strategies for post-EST pancreatitis.