title: Is high-dose nafamostat mesilate effective for the prevention of post-ERCP pancreatitis, especially in high-risk patients?
abstract: OBJECTIVE
  Infusion of the protease inhibitor nafamostat mesilate (20 mg) effectively prevents post-ERCP pancreatitis, but only in low-risk groups. This study was performed to evaluate the use of high-dose nafamostat mesilate (50 mg) for prevention of post-ERCP pancreatitis (PEP), especially in high-risk groups.
  
  
  METHODS
  A total of 608 patients who underwent ERCP were included; 13 patients were excluded. Patients were divided into 3 groups: controls (group A), infusion with 20 mg of nafamostat mesilate (group B), or infusion with 50 mg of nafamostat mesilate (group C). The incidence of PEP was analyzed.
  
  
  RESULTS
  The overall incidence of acute pancreatitis was 7.4% (44/595). There was a significant difference in the incidence of PEP with or without nafamostat mesilate (13.0% vs 4.0% and 5.1%, respectively; P < 0.0001). Subgroup analysis showed that in low-risk patients, the rate of PEP was significantly different with nafamostat (11.9% vs 2.7% and 4.0%, respectively; P = 0.007). In high-risk patients, the rate of PEP was not significantly different among treatment groups (14.6% vs 5.9% vs 6.9%, respectively; P = 0.108).
  
  
  CONCLUSIONS
  Nafamostat mesilate prophylaxis (20 or 50 mg) is effective in preventing post-ERCP pancreatitis. However, the preventive effect of high-dose nafamostat mesilate (50 mg) is not significant in high-risk patients.
authors.affiliation: Department of Internal Medicine, Pusan National University School of Medicine, Yangsan-si, Gyeongsangnam-do, South Korea.
authors.forename: Kee Tae
authors.initials: KT
authors.lastname: Park
authors.forename: Dae Hwan
authors.initials: DH
authors.lastname: Kang
authors.forename: Cheol Woong
authors.initials: CW
authors.lastname: Choi
authors.forename: Mong
authors.initials: M
authors.lastname: Cho
authors.forename: Su Bum
authors.initials: SB
authors.lastname: Park
authors.forename: Hyung Wook
authors.initials: HW
authors.lastname: Kim
authors.forename: Dong Uk
authors.initials: DU
authors.lastname: Kim
authors.forename: Chung Wook
authors.initials: CW
authors.lastname: Chung
authors.forename: Ki Tae
authors.initials: KT
authors.lastname: Yoon
mesh_terms: D000208:Acute Disease; D000368:Aged; D000681:Amylases / Q000097:blood; D001550:Benzamidines; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006146:Guanidines / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D011480:Protease Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D001550:Benzamidines; D006146:Guanidines; D011480:Protease Inhibitors; D000681:Amylases; C032855:nafamostat