Is high-dose nafamostat mesilate effective for the prevention of post-ERCP pancreatitis, especially in high-risk patients?

Abstract

OBJECTIVE:

Infusion of the protease inhibitor nafamostat mesilate (20 mg) effectively prevents post-ERCP pancreatitis, but only in low-risk groups. This study was performed to evaluate the use of high-dose nafamostat mesilate (50 mg) for prevention of post-ERCP pancreatitis (PEP), especially in high-risk groups.

METHODS:

A total of 608 patients who underwent ERCP were included; 13 patients were excluded. Patients were divided into 3 groups: controls (group A), infusion with 20 mg of nafamostat mesilate (group B), or infusion with 50 mg of nafamostat mesilate (group C). The incidence of PEP was analyzed.

RESULTS:

The overall incidence of acute pancreatitis was 7.4% (44/595). There was a significant difference in the incidence of PEP with or without nafamostat mesilate (13.0% vs 4.0% and 5.1%, respectively; P < 0.0001). Subgroup analysis showed that in low-risk patients, the rate of PEP was significantly different with nafamostat (11.9% vs 2.7% and 4.0%, respectively; P = 0.007). In high-risk patients, the rate of PEP was not significantly different among treatment groups (14.6% vs 5.9% vs 6.9%, respectively; P = 0.108).

CONCLUSIONS:

Nafamostat mesilate prophylaxis (20 or 50 mg) is effective in preventing post-ERCP pancreatitis. However, the preventive effect of high-dose nafamostat mesilate (50 mg) is not significant in high-risk patients.

• Authors: Kee Tae Park, Dae Hwan Kang, Cheol Woong Choi, Mong Cho, Su Bum Park, Hyung Wook Kim, Dong Uk Kim, Chung Wook Chung, Ki Tae Yoon
• Journal: Pancreas (Pancreas) Vol. 40 Issue 8 Pg. 1215-9 (Nov 2011) ISSN: 1536-4828 [Electronic] United States
• PMID: 21775918 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Benzamidines
• Guanidines
• Protease Inhibitors
• Amylases
• nafamostat

Topics

• Acute Disease
• Aged
• Amylases (blood)
• Benzamidines
• Cholangiopancreatography, Endoscopic Retrograde (adverse effects)
• Dose-Response Relationship, Drug
• Drug Administration Schedule
• Female
• Guanidines (administration & dosage, therapeutic use)
• Humans
• Infusions, Intravenous
• Male
• Middle Aged
• Pancreatitis (blood, etiology, prevention & control)
• Prospective Studies
• Protease Inhibitors (administration & dosage, therapeutic use)
• Risk Factors
• Time Factors
• Treatment Outcome