Are drugs a risk factor of post-ERCP pancreatitis?
BACKGROUND
Pancreatitis is the most severe complication of ERCP. The aim of this study was to assess whether the use of potentially pancreatotoxic drugs is a risk factor for post-ERCP pancreatitis.


METHODS
Risk factors for post-ERCP pancreatitis and all drugs taken during the month before ERCP were recorded retrospectively in a database. Patients with other causes of acute pancreatitis or chronic pancreatitis were excluded from the analysis. Post-ERCP pancreatitis was defined as abdominal pain and/or vomiting associated with amylase/lipase plasma levels equal to or greater than twice the upper normal value.


RESULTS
A total of 173 patients (95 men, 78 women; mean age, 68 [16] years) were included. Post-ERCP pancreatitis occurred in 31 patients (18%). Several risk factors were identified in a multivariate analysis: difficulty in cannulation (p<0.001), endoscopic sphincterotomy (p<0.005), and female gender (p=0.02). Having taken potent pancreatotoxic drugs increased the occurrence of post-ERCP pancreatitis: odds ratio 3.7: 95% confidence intervals [1.1,12.4], p=0.04.


CONCLUSIONS
Use of pancreatotoxic drugs before or during ERCP significantly increased the risk of post-ERCP pancreatitis. Thus, discontinuation of the use of such drugs before ERCP seems justified whenever possible.
Service de Médecine Interne E, Service d'Hépato-Gastroentérologie, Hôpital Saint Eloi, Montpellier Cedex 5, Montpellier, France.
Pascal
P
Perney
Emile
E
Berthier
Georges-Philippe
GP
Pageaux
Dominique
D
Hillaire-Buys
Valérie
V
Roques
Pascale
P
Fabbro-Peray
Marianne
M
Melki
Bertrand
B
Hanslik
Paul
P
Bauret
Dominique
D
Larrey
Jean-Pierre
JP
Blayac
François
F
Blanc
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001379:Azathioprine / Q000009:adverse effects; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D064420:Drug-Related Side Effects and Adverse Reactions; D004967:Estrogens / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D019804:Mesalamine / Q000009:adverse effects; D008875:Middle Aged; D009022:Morphine Derivatives / Q000009:adverse effects; D015999:Multivariate Analysis; D010195:Pancreatitis / Q000209:etiology*; D011241:Prednisone / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D014635:Valproic Acid / Q000009:adverse effects
D004967:Estrogens; D009022:Morphine Derivatives; D019804:Mesalamine; D014635:Valproic Acid; D001379:Azathioprine; D011241:Prednisone