Antiproteases in preventing post-ERCP acute pancreatitis

Area of Science:

• Gastroenterology and Hepatology
• Pharmacology
• Surgical Complications

Background:

• Post-ERCP pancreatitis is a common and serious complication.
• Existing pharmacological prevention strategies have largely failed.
• Proteolytic enzyme activation is a key factor in post-ERCP pancreatitis pathogenesis.

Purpose of the Study:

• To evaluate the efficacy of antiproteases, gabexate and ulinastatin, in preventing post-ERCP pancreatitis.
• To compare the effectiveness and cost-efficiency of gabexate and ulinastatin.

Main Methods:

• Review of randomized controlled trials evaluating gabexate and ulinastatin for post-ERCP pancreatitis prevention.
• Analysis of drug administration protocols (long-term vs. short-term infusion) and their impact on efficacy.
• Consideration of drug half-life, cost, and hospitalization requirements.

Main Results:

• Long-term gabexate infusion (12 hours) significantly reduced post-ERCP pancreatitis, but short-term infusions were ineffective.
• Short-term ulinastatin administration (10 minutes) showed significant preventive effects in one trial.
• Ulinastatin is more cost-effective than gabexate due to shorter administration and no need for additional hospitalization.

Conclusions:

• Both long-term gabexate and short-term ulinastatin show potential in reducing post-ERCP pancreatitis in average-risk patients.
• Ulinastatin offers a more practical and cost-effective approach compared to gabexate.
• Further large-scale, placebo-controlled trials are necessary to confirm efficacy, especially in high-risk patient populations.