title: Pharmacologic treatment can prevent pancreatic injury after ERCP: a meta-analysis.
abstract: BACKGROUND
  The identification of therapeutic agents that can prevent the pancreatic injury after endoscopic retrograde cholangiopancreatography (ERCP) is of considerable importance.
  
  
  METHODS
  We performed a meta-analysis including 28 clinical trials on the use of somatostatin (12 studies), octreotide (10 studies), and gabexate mesilate (6 studies) after ERCP. Outcome measures evaluated were the incidence of acute pancreatitis, hyperamylasemia, and pancreatic pain. Three analyses were run separately: for all available studies, for randomized trials only, and for only those studies published as complete reports.
  
  
  RESULTS
  When all available studies were analyzed, somatostatin and gabexate mesilate were significantly associated with improvements in all three outcomes. Odds ratios (OR) for gabexate mesilate were 0.27 (95% CI [0.13, 0. 57], p = 0.001) for acute pancreatitis, 0.66 (95% CI [0.48, -0.89], p = 0.007) for hyperamylasemia, and 0.33 (95% CI [0.18, 0.58], p = 0. 0005) for post-procedural pain. Somatostatin reduced acute pancreatitis (OR 0.38: 95% CI [0.22, 0.65], p < 0.001), pain (OR 0. 24: 95% CI [0.14, 0.42], p < 0.001), and hyperamylasemia (OR 0.65: 95% CI [0.48, 0.90], p = 0.008). Octreotide was associated only with a reduced risk of post-ERCP hyperamylasemia (OR 0.51: 95% CI [0.31, 0.83], p = 0.007) but had no effect on acute pancreatitis and pain. The statistical significance of data did not change after analyzing randomized trials only or studies published as complete reports. For each considered outcome, the publication bias assessment and the number of patients that need to be treated to prevent one adverse effect were, respectively, higher and lower for somatostatin than for gabexate mesilate.
  
  
  CONCLUSIONS
  The pancreatic injury after ERCP can be prevented with the administration of either somatostatin or gabexate mesilate, but the former agent is more cost-effective. Additional studies comparing the efficacy of short-term infusion of somatostatin versus gabexate mesilate in patients at high risk for post-ERCP complications seem warranted.
authors.affiliation: Divisions of Gastroenterology, Ospedale "Casa Sollievo della Sofferenza," IRCCS, San Giovanni Rotondo, and Ospedale "De Bellis," IRCCS, Castellana Grotte, Internal Medicine, Catholic University, Rome, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Andriulli
authors.forename: G
authors.initials: G
authors.lastname: Leandro
authors.forename: G
authors.initials: G
authors.lastname: Niro
authors.forename: A
authors.initials: A
authors.lastname: Mangia
authors.forename: V
authors.initials: V
authors.lastname: Festa
authors.forename: G
authors.initials: G
authors.lastname: Gambassi
authors.forename: M R
authors.initials: MR
authors.lastname: Villani
authors.forename: D
authors.initials: D
authors.lastname: Facciorusso
authors.forename: P
authors.initials: P
authors.lastname: Conoscitore
authors.forename: F
authors.initials: F
authors.lastname: Spirito
authors.forename: G
authors.initials: G
authors.lastname: De Maio
mesh_terms: D000208:Acute Disease; D000681:Amylases / Q000378:metabolism; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D016670:Gabexate / Q000627:therapeutic use*; D006728:Hormones / Q000627:therapeutic use; D006801:Humans; D015282:Octreotide / Q000627:therapeutic use*; D010146:Pain / Q000517:prevention & control; D010179:Pancreas / Q000293:injuries*; D010195:Pancreatitis / Q000209:etiology / Q000517:prevention & control; D015842:Serine Proteinase Inhibitors / Q000627:therapeutic use*; D013004:Somatostatin / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D006728:Hormones; D015842:Serine Proteinase Inhibitors; D016670:Gabexate; D013004:Somatostatin; D000681:Amylases; D015282:Octreotide