Intravenous synthetic secretin reduces the incidence of pancreatitis induced by endoscopic retrograde cholangiopancreatography.

Abstract

OBJECTIVES:

This study aimed to evaluate whether synthetic secretin is effective in reducing post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis.

METHODS:

This is a single academic medical center, prospective, randomized, double-blind, placebo-controlled trial using secretin (dose of 16 μg) administered intravenously immediately before ERCP. Patients were evaluated for the primary outcome of post-ERCP pancreatitis as diagnosed by a single investigator.

RESULTS:

A total of 1100 patients were screened, of whom 869 were randomly assigned to receive secretin (n = 426) or placebo (n = 443) before ERCP and were evaluated after the procedure for efficacy of secretin. The incidence of pancreatitis in the secretin group compared with the placebo group was 36 (8.7%) of 413 patients versus 65 (15.1%) of 431 patients, respectively, P = 0.004. In the subgroup analysis, secretin was highly protective against post-ERCP pancreatitis for patients undergoing biliary sphincterotomy (6/129 vs 32/142, P < 0.001), patients undergoing cannulation of the common bile duct (26/339 vs 56/342, P < 0.001), and patients not undergoing pancreatic sphincterotomy (26/388 vs 57/403, P = 0.001). Analysis of the interaction between these groups reveals that the primary effect of secretin prophylaxis was prevention of post-ERCP pancreatitis in patients undergoing biliary sphincterotomy.

CONCLUSIONS:

Synthetic secretin reduces the risk of post-ERCP pancreatitis, particularly in patients in undergoing biliary sphincterotomy.

• Authors: Paul S Jowell, Malcolm S Branch, Seymour H Fein, Edward D Purich, Rakhi Kilaru, Gail Robuck, Philip d'Almada, John Baillie
• Journal: Pancreas (Pancreas) Vol. 40 Issue 4 Pg. 533-9 (May 2011) ISSN: 1536-4828 [Electronic] United States
• PMID: 21499206 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Gastrointestinal Agents
• Secretin

Topics

• Adult
• Aged
• Cholangiopancreatography, Endoscopic Retrograde (adverse effects, methods)
• Double-Blind Method
• Female
• Gastrointestinal Agents (administration & dosage, therapeutic use)
• Humans
• Injections, Intravenous
• Male
• Middle Aged
• Pancreatitis (etiology, prevention & control)
• Postoperative Complications (etiology, prevention & control)
• Prospective Studies
• Secretin (administration & dosage, therapeutic use)
• Treatment Outcome