title: Oral allopurinol does not prevent the frequency or the severity of post-ERCP pancreatitis.
abstract: BACKGROUND
  Pancreatitis is the most common major complication of ERCP. Efforts have been made to identify pharmacologic agents capable of reducing its incidence and severity. The aim of this trial was to determine whether prophylactic allopurinol, an inhibitor of oxygen-derived free radical production, would reduce the frequency and severity of post-ERCP pancreatitis. Methods A total of 701 patients were randomized to receive either allopurinol or placebo 4 hours and 1 hour before ERCP. A database was prospectively collected by a defined protocol on patients who underwent ERCP. Standardized criteria were used to diagnose and grade the severity of postprocedure pancreatitis.
  
  
  RESULTS
  The groups were similar with regard to patient demographics and to patient and procedure risk factors for pancreatitis. The overall incidence of pancreatitis was 12.55%. It occurred in 46 of 355 patients in the allopurinol group (12.96%) and in 42 of 346 patients in the control group (12.14%; p = 0.52). The pancreatitis was graded mild in 7.89%, moderate in 4.51%, and severe in 0.56% of the allopurinol group, and mild in 6.94%, moderate in 4.62%, and severe in 0.58% of the control group. There was no significant difference between the groups in the frequency or the severity of pancreatitis.
  
  
  CONCLUSIONS
  Prophylactic oral allopurinol did not reduce the frequency or the severity of post-ERCP pancreatitis.
authors.affiliation: Indiana University Medical Center, Indianapolis, 46202, USA.
authors.forename: Patrick
authors.initials: P
authors.lastname: Mosler
authors.forename: Stuart
authors.initials: S
authors.lastname: Sherman
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Marks
authors.forename: James L
authors.initials: JL
authors.lastname: Watkins
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Geenen
authors.forename: Priya
authors.initials: P
authors.lastname: Jamidar
authors.forename: Evan L
authors.initials: EL
authors.lastname: Fogel
authors.forename: Laura
authors.initials: L
authors.lastname: Lazzell-Pannell
authors.forename: M'hamed
authors.initials: M
authors.lastname: Temkit
authors.forename: Paul
authors.initials: P
authors.lastname: Tarnasky
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Block
authors.forename: James T
authors.initials: JT
authors.lastname: Frakes
authors.forename: Arif A
authors.initials: AA
authors.lastname: Aziz
authors.forename: Pramod
authors.initials: P
authors.lastname: Malik
authors.forename: Nicholas
authors.initials: N
authors.lastname: Nickl
authors.forename: Adam
authors.initials: A
authors.lastname: Slivka
authors.forename: John
authors.initials: J
authors.lastname: Goff
authors.forename: Glen A
authors.initials: GA
authors.lastname: Lehman
mesh_terms: D000284:Administration, Oral; D000493:Allopurinol / Q000008:administration & dosage*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D004311:Double-Blind Method; D005260:Female; D016166:Free Radical Scavengers / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D016166:Free Radical Scavengers; D000493:Allopurinol