title: Nafamostat for Prophylaxis against Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis Compared with Gabexate.
abstract: OBJECTIVE
  The protease inhibitors, nafamostat and gabexate, have been used to prevent pancreatitis related to endoscopic retrograde cholangiopancreatography (ERCP). In vitro, nafamostat inhibits the pancreatic protease activities 10-100 times more potently than gabexate. We evaluated the efficacy of nafamostat for prophylaxis against post-ERCP pancreatitis in comparison with gabexate.
  
  
  METHODS
  Five hundred patients (208 patients in the nafamostat-treated group and 292 in the gabexate-treated group) were analyzed retrospectively after selective exclusion. The incidences of pancreatitis and hyperamylasemia after the ERCP were compared between the nafamostat and gabexate groups.
  
  
  RESULTS
  The incidences of acute pancreatitis and hyperamylasemia were 9.1% and 40.9%, respectively, in the nafamostat-treated group, and 8.6% and 39.4% in the gabexate-treated group. The frequencies of post-ERCP pancreatitis and hyperamylasemia did not differ significantly between the two groups, Post-ERCP pancreatitis in two group did not vary according to the different ERCP procedures. The mean serum amylase level at 6 h after ERCP was significantly lower in the nafamostat-treated group than in the gabexate-treated group (p=0.020). However, the difference in serum amylase level did not persist at 18 h and 36 h post-ERCP.
  
  
  CONCLUSIONS
  Administration of nafamostat before ERCP was not inferior to gabexate in protecting against the development of pancreatitis.
authors.affiliation: Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Jae Hyuck
authors.initials: JH
authors.lastname: Chang
authors.forename: In Seok
authors.initials: IS
authors.lastname: Lee
authors.forename: Hyung Keun
authors.initials: HK
authors.lastname: Kim
authors.forename: Yu Kyung
authors.initials: YK
authors.lastname: Cho
authors.forename: Jae Myung
authors.initials: JM
authors.lastname: Park
authors.forename: Sang Woo
authors.initials: SW
authors.lastname: Kim
authors.forename: Myung-Gyu
authors.initials: MG
authors.lastname: Choi
authors.forename: In-Sik
authors.initials: IS
authors.lastname: Chung