Does gabexate mesilate affect serum concentrations of acute phase proteins after endoscopic retrograde cholangiopancreatography examination?
OBJECTIVE
To explore the possibility that the preventive effect of gabexate mesilate on endoscopic retrograde cholangiopancreatography-related acute pancreatitis may be mediated by its modulation of acute phase proteins.


METHODS
Thirty consecutive patients who underwent endoscopic retrograde cholangiopancreatography were randomly assigned to receive 1g of gabexate mesilate (13 patients) or a placebo (17 patients) by continuous i.v. infusion starting 30 minutes before the endoscopy session and continuing for 12 hours afterward. In all patients, C-reactive protein, serum amyloid A and interleukin 6 serum concentrations were determined before endoscopy and 4, 8, 12 and 24 hours afterward.


RESULTS
Interleukin 6 basal serum concentrations were not statistically different between patients who had been treated with gabexate mesilate and those who had received the placebo (P = 0.279), whereas C-reactive protein (P = 0.033) and serum amyloid A (P = 0.022) basal values were significantly lower in the gabexate mesilate group than in the placebo group. Compared to basal values, serum interleukin 6 concentrations significantly increased at 4 (P = 0.048) and at 8 (P = 0.025) hours; the increase of serum interleukin 6 concentrations was not significant at 12 (P = 0.092), but became significant at 24 (P = 0.025) hours. C-reactive protein and serum amyloid A serum concentrations increased significantly only at 12 (P = 0.001, P = 0.012, respectively) and 24 (P < 0.001, P = 0.013, respectively) hours. The modifications of serum concentrations of interleukin 6, C-reactive protein and serum amyloid A were not significantly different between the gabexate mesilate and the placebo groups.


CONCLUSIONS
Gabexate mesilate does not affect serum concentrations of acute phase proteins after endoscopic retrograde cholangiopancreatography examination and it is able to prevent acute pancreatitis related to endoscopic retrograde cholangiopancreatography via a different mechanism than that explored in this study.
Pezzilli
Raffaele
R
Department of Internal Medicine, Azienda Ospedaliera Policlinico S. Orsola-Malpighi, Bologna, Italy. pezzilli@orsola-malpighi.med.unibo.it
Gabbrielli
Armando
A
Labate
Antonio Maria Morselli
AM
D'Alessio
Pasquale
P
Barakat
Bahjat
B
Costamagna
Guido
G
Dibenedetti
Francesco
F
Massa
Margherita
M
Merlini
Giovanni
G
d'Eril
Gianvico Melzi
GM
D000208:Acute Disease; D000209:Acute-Phase Proteins / Q000378:metabolism*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000378:metabolism; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D005260:Female; D016670:Gabexate / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007262:Infusions, Intravenous; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000097:blood / Q000517:prevention & control*; D011292:Premedication; D015842:Serine Proteinase Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D000685:Serum Amyloid A Protein / Q000378:metabolism
D000209:Acute-Phase Proteins; D015850:Interleukin-6; D015842:Serine Proteinase Inhibitors; D000685:Serum Amyloid A Protein; D016670:Gabexate; D002097:C-Reactive Protein