Somatostatin and gabexate for post-endoscopic retrograde cholangiopancreatography pancreatitis prevention: meta-analysis of randomized placebo-controlled trials.
OBJECTIVE
Prior studies have suggested the efficacy of somatostatin and gabexate in post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis prevention. We examined this notion in our study.


METHODS
An extensive literature search led to the inclusion of seven homogeneous high-quality studies (Jadad score >or=4), involving 3,130 patients. The studies were grouped according to the drug's length of administration: given as an infusion for 12 h (groups SOM1 and GAB1 for somatostatin and gabexate, respectively); given as an infusion for less then 12 h (groups SOM2 and GAB2 for somatostatin and gabexate, respectively); and given as a bolus (group SOM3 for somatostatin, none identified for gabexate). Separate meta-analyses investigating post-procedural pancreatitis and hyperamylasemia rates were conducted in a random effects model.


RESULTS
Pancreatitis analyses yielded significant risk differences for the SOM1, SOM3 and GAB1 groups. The resulting values were 7.7% (95% confidence intervals [CI][3.4 to 12.0], P < 0.0001), 8.2% (95% CI [4.4 to 12.0], P < 0.0001) and 5.2% (95% CI [1.1 to 9.4], P = 0.01), respectively. No statistically significant risk differences were observed for the SOM2 and GAB2 groups: -2.3% (95% CI [-5.2 to 0.5], P = 0.11) and -1.1% (95% CI [-3.8 to 1.6], P = 0.41), respectively. Hyperamylasemia analyses yielded significant risk differences for the SOM1 and SOM3 groups (P = 0.017 and 0.001, respectively), although not for the SOM2, GAB1 and GAB2 groups (P = 0.44, 0.49 and 0.47, respectively).


CONCLUSIONS
Somatostatin administered as a bolus seems to be an efficacious measure of post-ERCP pancreatitis prevention, reducing pancreatitis and hyperamylasemia rates, and being applicable to clinical practice. Further study is required before its introduction into routine care.
Rudin
Dan
D
Department of Internal Medicine, Staten Island University Hospital, 475 Seaview Avenue Staten Island, NY 10305, USA. drudin@siuh.edu
Kiss
Alexander
A
Wetz
Robert V
RV
Sottile
Vincent M
VM
D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D016670:Gabexate / Q000627:therapeutic use*; D006801:Humans; D010195:Pancreatitis / Q000209:etiology* / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D015842:Serine Proteinase Inhibitors / Q000627:therapeutic use*; D013004:Somatostatin / Q000627:therapeutic use*
D015842:Serine Proteinase Inhibitors; D016670:Gabexate; D013004:Somatostatin