A comparative study of contrast agents for endoscopic retrograde pancreatography.
Pancreatitis is a major cause of morbidity and mortality secondary to endoscopic retrograde pancreatography (ERP). One factor that may cause post-ERP pancreatitis is the type of contrast media utilized during the procedure. The purpose of this prospective, double-blind, randomized study was to evaluate the effects of three contrast agents of differing osmolality and ionicity on changes between pre- and post-ERP chemical changes in serum amylase and lipase and development of clinical symptoms of acute pancreatitis. Our study of 53 patients showed that those who received Omnipaque a non-ionic, relatively iso-osmolar contrast agent, had a significantly lower serum amylase (p = 0.0038) and serum lipase (p = 0.0002) in post-ERP serological markers, compared with patients who received the ionic agents, Hypaque meglumine 60% or Hexabrix. In addition, the development of clinical symptoms of pancreatitis was less in patients who received Omnipaque than in those who received Hexabrix or Hypaque (1 vs. 3 vs. 4). No significant difference was found between patients who received ionic agents. No patient who received Omnipaque needed hospitalization, whereas one (6%) patient who received Hexabrix was hospitalized compared to three (20%) hospitalized patients who received Hypaque. When the initial cost and cost of hospitalization were compared, the non-ionic contrast medium was also found to be more cost-effective for the patient. In summary, the risk of post-ERP acute pancreatitis was significantly lower for patients who received the non-ionic contrast agent than for those who received the ionic agents.
Barkin
J S
JS
Division of Gastroenterology, University of Miami, School of Medicine/Mt. Sinai Medical Center, Florida.
Casal
G L
GL
Reiner
D K
DK
Goldberg
R I
RI
Phillips
R S
RS
Kaplan
S
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000379:methods*; D003974:Diatrizoate Meglumine; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007472:Iohexol; D007485:Ioxaglic Acid; D008297:Male; D008875:Middle Aged; D009994:Osmolar Concentration; D010195:Pancreatitis / Q000209:etiology
D003974:Diatrizoate Meglumine; D007472:Iohexol; D007485:Ioxaglic Acid