Somatostatin Effective Prophylaxis for Post-ERCP Pancreatitis

December 18, 2003

Yael Waknine

Dec. 18, 2003 — A single dose of intravenous bolus somatostatin given immediately after diagnostic endoscopic retrograde cholangiopancreatography (ERCP) is effective in reducing the incidence of pancreatitis after therapeutic ERCP, according to the results of a randomized, double-blind, controlled trial published in the December issue of Gut.

"Acute pancreatitis is a common complication of ERCP, with an incidence of 8% to 18% in prospective studies," write R. T-P Poon, and colleagues, from the Department of Surgery at Queen Mary Hospital in Hong Kong, China. Patients undergoing endoscopic sphincterotomy or other therapeutic procedures are at a "higher risk of post-ERCP pancreatitis than those undergoing diagnostic ERCP alone, presumably because of thermal or mechanical injury to papilla and pancreatic orifice," the authors write.

After diagnostic ERCP, 270 patients requiring sphincterotomy or other therapeutic procedures were randomized into two equal groups and were comparable in terms of age, sex, incidence of previous pancreatitis, and indications for therapeutic ERCP. Prior to ERCP, patients in the treatment group received a bolus intravenous injection of 250 µg somatostatin, while those in the placebo group were administered a bolus of volume-equivalent saline solution.

The incidence of clinical pancreatitis was significantly lower in the somatostatin group than in the placebo group (4.4% vs. 13.3%; P = .01). Although pre-ERCP serum amylase levels were similar between the two groups (median, 69 vs. 72 IU/L; P = .433), both six- and 24-hour post-ERCP serum amylase levels were lower in the somatostatin cohort compared with the placebo group (median, 135 vs. 210 IU/L; P = .028 and median, 128 vs. 182 IU/L; P = .007, respectively).

In addition, fewer patients were in pain in the somatostatin group compared with the placebo group (16 patients [12%] vs. 27 patients [20%]; P = .067). Although not significant, "the reduced incidence of post-ERCP abdominal pain was mainly due to the decrease in the frequency of pancreatitis, as the number of patients with abdominal pain not related to pancreatitis was similar between the two groups (10 and nine patients, respectively)," the investigators write.

Compared with the placebo group, median hospital stay was lower in the somatostatin group (2 vs. 3 days; P = .048). Of the patients who did develop post-ERCP pancreatitis, those in the somatostatin group had a shorter hospital stay compared with those in the placebo group (48 vs. 94 days). Overall, patients who received somatostatin had a 0.34-day decrease in hospital stay. According to the authors, the cost of one dose of somatostatin at their institution is $15, while the average cost of 0.34 days of hospital stay of $130.

"A single dose of intravenous bolus somatostatin given immediately after diagnostic cholangiopancreatography can decrease the incidence of pancreatitis after sphincterotomy or other therapeutic ERCP procedures," the authors write. "The use of the cheapest drug available, administered in the least costly way to a selected high risk group of patients may offer the real possibility of cost effective prophylaxis of post-ERCP pancreatitis," they conclude.

Gut. 2003;52:1768-1773

Reviewed by Gary D. Vogin, MD

Yael Waknine is a freelance writer for Medscape.

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