Pancreatic reaction after endoscopic papillosphincterotomy (EPT) is a common event occurring in about 70% of cases.
Acute pancreatitis may also develop in 1%-6% of cases. Previous attempts to prevent this reaction with an inhibitor of exocrine pancreatic secretion such as
somatostatin provided conflicting results. The
somatostatin long-acting analogue
octreotide has recently proposed for the prevention of ERCP/EPT-induced pancreatic reaction. Therefore we tested the prophylactic effect of a subcutaneous administration of
octreotide in two different dosages in 60 consecutive patients undergoing EPT for common bile duct stones and benign papillary
stenosis. They were given either
octreotide 0.2 mg (20 cases), or
octreotide 0.1 mg (20 cases), or placebo (20 cases) before the procedure. Serum
amylase levels were determined at baseline and 2, 4, 8 and 24 hours thereafter. The differences were statistically significant at 2 hours between subjects pretreated with
octreotide 0.2 mg and control subjects (p = 0.01); at 4 and 8 hours after the procedure between both
octreotide-treated groups and control subjects (
octreotide 0.1 mg: p < 0.05, at 4 and 8 hrs;
octreotide 0.2 mg: p = 0.01, at 4 hrs, and p < 0.01, at 8 hrs). In patients with previous episodes of relapsing
pancreatitis, the increase in serum
amylase was significantly reduced in the
octreotide 0.2 mg group vs control group, at 4 hrs (p < 0.05) and 8 hrs (p < 0.05). Our data suggest that
octreotide 0.2 mg has a greater prophylactic efficacy than 0.1 mg in reducing pancreatic reaction after EPT.