Can a single dose corticosteroid reduce the incidence of post-ERCP pancreatitis? A randomized, prospective control study.
BACKGROUND
Acute pancreatitis is one of the complications after Endoscopic retrograde cholangio pancreatography (ERCP) and it could be fatal. Several drugs were used to prevent or decrease this complication. Corticosteroid is one of the medications which may have such potential. It is affordable and available everywhere.


OBJECTIVE
To compare the incidence of post-ERCP pancreatitis in patients receiving single dose corticosteroid prior to the procedure with that of the control group .


METHODS
A prospective randomized controlled double-blinded study.


METHODS
A total of 120 patients were randomized to receive either intravenous hydrocortisone 100 mg. or normal saline 1 hour prior to the procedure. The serum amylase levels were recorded 4 and 24 hours after the procedure. Abdominal pain and back pain were also recorded. Patients were diagnosed as having post-ERCP pancreatitis if ones had new or worsened epigastric pain with or without radiation to the back combined with elevation of serum amylase more than 2.5 times the upper limit.


RESULTS
The overall incidence of pancreatitis was 6.67% with 1.64% in the study group compared with 11.86% in the control group (p = 0.031). The groups were similar with regard to age, gender, type of procedure performed (diagnostic or therapeutic), difficulty of cannulation, concentration of contrast media and pre operative amylase level.


CONCLUSIONS
The results of the present trial indicate that hydrocortisone could reduce the risk of post-ERCP pancreatitis.
Kwanngern
Kris
K
Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Tiyapattanaputi
Prawes
P
Wanitpukdeedecha
Mongkol
M
Navicharern
Patpong
P
D000208:Acute Disease; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage* / Q000627:therapeutic use; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control; D011292:Premedication; D012307:Risk Factors; D013997:Time Factors
D000893:Anti-Inflammatory Agents; D006854:Hydrocortisone