Frequency of post-ERCP pancreatitis in a single tertiary referral centre without and with routine prophylaxis with gabexate: a 6-year survey and cost-effectiveness analysis.

Abstract

BACKGROUND AND STUDY AIMS:

Several drugs have been used for the prevention of post-ERCP pancreatitis with conflicting results and no data referring to the routine use of a pharmacological prophylaxis have been published up to now. Aim of the study was to evaluate the frequency of post-ERCP pancreatitis and costs in a series of consecutive patients who have undergone ERCP procedures before and after the introduction of a routine prophylaxis with gabexate in all cases.

PATIENTS AND METHODS:

Data from 1312 patients who underwent ERCP procedures without gabexate prophylaxis and from 1149 consecutive patients with 1g i.v. gabexate, were retrospectively evaluated during a 6-year period. Patients were also subdivided in standard- and high-risk subjects, on the basis of patient- and technique-related risk factors: 984 subjects (39.9%) had one or more conditions that placed them at high risk for post-ERCP pancreatitis.

RESULTS:

Post-ERCP pancreatitis was reported in 76 out of 2461 patients (3.1%). The frequency of pancreatitis appeared significantly reduced in the gabexate period in comparison with before gabexate in overall cases (2.2% versus 3.9%; p=0.019); however, the reduction was significant only for high-risk patients (3.8% versus 7.3%; p=0.001). Severe hyperamylasaemia at 4-6h and 24h after the procedure was also significantly reduced only in high-risk patients (p=0.001). Routine prophylaxis with gabexate appeared cost-effective in high-risk patients.

CONCLUSIONS:

Routine gabexate prophylaxis was associated with a significant reduction of post-ERCP pancreatitis rate, severe hyperamylasaemia and hospitalisation-related costs only in high-risk patients. However, gabexate appeared unable to reduce the incidence of severe pancreatitis.

• Authors: P A Testoni, A Mariani, E Masci, S Curioni
• Journal: Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver (Dig Liver Dis) Vol. 38 Issue 8 Pg. 588-95 (Aug 2006) ISSN: 1590-8658 [Print] Netherlands
• PMID: 16731060 (Publication Type: Journal Article)

Chemical References

• Serine Proteinase Inhibitors
• Gabexate
• Amylases

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Amylases (blood, drug effects)
• Child
• Child, Preschool
• Cholangiopancreatography, Endoscopic Retrograde (adverse effects, economics)
• Cost-Benefit Analysis
• Data Collection
• Female
• Follow-Up Studies
• Gabexate (economics, therapeutic use)
• Humans
• Hyperamylasemia (epidemiology, etiology, prevention & control)
• Incidence
• Italy (epidemiology)
• Male
• Middle Aged
• Pancreatitis (epidemiology, etiology, prevention & control)
• Referral and Consultation
• Retrospective Studies
• Risk Factors
• Serine Proteinase Inhibitors (economics, therapeutic use)
• Treatment Outcome