Nafamostat mesylate in the prevention of post-ERCP pancreatitis and risk factors for post-ERCP pancreatitis.

Abstract

BACKGROUND:

Pancreatitis is a major complication of ERCP.

OBJECTIVE:

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

DESIGN:

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

SETTING:

A large tertiary-referral center.

PATIENTS:

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

INTERVENTION:

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.

MAIN OUTCOME MEASUREMENTS:

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.

LIMITATIONS:

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.

• Authors: Cheol Woong Choi, Dae Hwan Kang, Gwang Ha Kim, Jae Sup Eum, Sun Mi Lee, Geun Am Song, Dong Uk Kim, Il Doo Kim, Mong Cho
• Journal: Gastrointestinal endoscopy (Gastrointest Endosc) Vol. 69 Issue 4 Pg. e11-8 (Apr 2009) ISSN: 1097-6779 [Electronic] United States
• PMID: 19327467 (Publication Type: Journal Article, Randomized Controlled Trial)

Chemical References

• Anti-Inflammatory Agents, Non-Steroidal
• Benzamidines
• Guanidines
• nafamostat

Topics

• Aged
• Anti-Inflammatory Agents, Non-Steroidal (therapeutic use)
• Benzamidines
• Cholangiopancreatography, Endoscopic Retrograde (adverse effects)
• Double-Blind Method
• Female
• Guanidines (therapeutic use)
• Humans
• Male
• Middle Aged
• Pancreatitis (etiology, prevention & control)
• Prospective Studies
• Risk Factors