Octreotide in the prevention of pancreatic damage induced by endoscopic sphincterotomy.
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.
Hardt
P D
PD
Med. Klinik III und Poliklinik der JLU Giessen, Rodthohl 6, D-35385 Giessen, Germany. Philip.D.Hardt@innere.med.uni-giessen.de
Kress
O
O
Fadgyas
T
T
Doppl
W
W
Schnell-Kretschmer
H
H
Wüsten
O
O
Klör
H U
HU
D000208:Acute Disease; D000681:Amylases / Q000097:blood; D004311:Double-Blind Method; D042882:Gallstones / Q000601:surgery; D006728:Hormones / Q000008:administration & dosage*; D006801:Humans; D008049:Lipase / Q000097:blood; D015282:Octreotide / Q000008:administration & dosage*; D010179:Pancreas / Q000201:enzymology; D010195:Pancreatitis / Q000188:drug therapy / Q000517:prevention & control*; D011183:Postoperative Complications / Q000188:drug therapy / Q000517:prevention & control*; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects*
D006728:Hormones; D008049:Lipase; D000681:Amylases; D015282:Octreotide