Nafamostat mesylate in the prevention of post-ERCP pancreatitis and risk factors for post-ERCP pancreatitis.
BACKGROUND
Pancreatitis is a major complication of ERCP.


OBJECTIVE
To determine whether nafamostat mesylate prophylaxis decreases the incidence of post-ERCP pancreatitis (PEP).


METHODS
A single-center, randomized, double-blinded, controlled trial.


METHODS
A large tertiary-referral center.


METHODS
From January 2005 to December 2007, a total of 704 patients who underwent ERCP were analyzed.


METHODS
Patients received continuous infusion of 500 mL of 5% dextrose solution with 20 mg of nafamostat mesylate (354 patients) or without 20 mg of nafamostat mesylate (350 patients). Serum amylase and lipase levels were checked before ERCP, 4 and 24 hours after ERCP, and when clinically indicated.


METHODS
The incidence of PEP and risk factors associated with the development of PEP.


RESULTS
The incidence of acute pancreatitis was 5.4%. There was a significant difference in the incidence of PEP between the nafamostat mesylate and control groups (3.3% vs 7.4%, respectively; P = .018). Univariate analysis identified history of acute pancreatitis (P < .001), difficult cannulation (P = .023), periampullary diverticulum (P = .004), age younger than 40 years (P = .009), and >/=5 pancreatic-duct contrast injections (odds ratio [OR] 2.736, P = .012) as statistically significant risk factors.


CONCLUSIONS
A single-center study.


CONCLUSIONS
Nafamostat mesylate prophylaxis is partially effective in preventing post-ERCP pancreatitis. Independent risk factors for PEP are a history of acute pancreatitis and multiple pancreatic-duct contrast injections.
Choi
Cheol Woong
CW
Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.
Kang
Dae Hwan
DH
Kim
Gwang Ha
GH
Eum
Jae Sup
JS
Lee
Sun Mi
SM
Song
Geun Am
GA
Kim
Dong Uk
DU
Kim
Il Doo
ID
Cho
Mong
M