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Prophylactic administration of somatostatin or gabexate does not prevent pancreatitis after ERCP: an updated meta-analysis.
Gastrointest Endosc. 2007 Apr; 65(4):624-32.GE

Abstract

BACKGROUND

The prophylactic use of somatostatin or gabexate in patients undergoing ERCP is still controversial.

OBJECTIVE

Our purpose was to update the meta-analysis on somatostatin (SS, 16 studies) or gabexate mesylate (GM, 9 studies) prophylaxis of post-ERCP pancreatitis and to run sensitivity analyses by subgrouping trials according to schedules of drug administration.

MAIN OUTCOME MEASUREMENTS

Post-ERCP acute pancreatitis, hyperamylasemia, and pain.

RESULTS

Heterogeneity was present among selected studies, which appeared eliminated when only 9 high-quality trials on SS and 5 randomized studies on GM were considered. After data were pooled from SS trials, pancreatitis occurred in 7.3% of controls versus 5.3% of treated patients, a nonsignificant effect (odds ratio [OR] = 0.73; 95% CI 0.54-1.006). The funnel plot showed asymmetry with a negative slope (P = .05). The meta-analysis produced negative results for either short- (<6 hours) or long-term (> or =12 hours) SS infusion, whereas a bolus injection proved effective (OR = 0.271; 95% CI 0.138-0.536), with a pooled absolute risk reduction of 8.2% (95% CI 4.4-12.0%). Postprocedural hyperamylasemia, but not pain, was significantly reduced (OR = 0.67, 95% CI 0.57-0.81). In controls and patients treated with GM, pancreatitis developed in 5.7% versus 4.8%, hyperamylasemia in 40.6% versus 36.9%, and pain in 1.7% versus 8.9%. All pooled ORs were nonsignificant: P = .34, .17, and .19, respectively. The meta-analysis produced no significant effect for either short-term (<6 hours) or long-term (>12 hours) GM administration.

CONCLUSION

Short- or long-term infusion of SS or GM proved ineffective in reducing post-ERCP pancreatitis and pain. The beneficial effect of SS on postprocedural hyperamylasemia seems of marginal significance. When given as a bolus injection, SS maintains its promise in this field, but additional data are needed.

Authors+Show Affiliations

Division of Gastroenterology, Casa Sollievo Sofferenza and De Bellis Hospitals, Istituto di Ricovero e Cura a Carattere Scientifico, San Giovanni Rotondo, Italy.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis

Language

eng

PubMed ID

17383459

Citation

Andriulli, Angelo, et al. "Prophylactic Administration of Somatostatin or Gabexate Does Not Prevent Pancreatitis After ERCP: an Updated Meta-analysis." Gastrointestinal Endoscopy, vol. 65, no. 4, 2007, pp. 624-32.
Andriulli A, Leandro G, Federici T, et al. Prophylactic administration of somatostatin or gabexate does not prevent pancreatitis after ERCP: an updated meta-analysis. Gastrointest Endosc. 2007;65(4):624-32.
Andriulli, A., Leandro, G., Federici, T., Ippolito, A., Forlano, R., Iacobellis, A., & Annese, V. (2007). Prophylactic administration of somatostatin or gabexate does not prevent pancreatitis after ERCP: an updated meta-analysis. Gastrointestinal Endoscopy, 65(4), 624-32.
Andriulli A, et al. Prophylactic Administration of Somatostatin or Gabexate Does Not Prevent Pancreatitis After ERCP: an Updated Meta-analysis. Gastrointest Endosc. 2007;65(4):624-32. PubMed PMID: 17383459.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prophylactic administration of somatostatin or gabexate does not prevent pancreatitis after ERCP: an updated meta-analysis. AU - Andriulli,Angelo, AU - Leandro,Gioacchino, AU - Federici,Telemaco, AU - Ippolito,Antonio, AU - Forlano,Rosario, AU - Iacobellis,Angelo, AU - Annese,Vito, PY - 2006/07/18/received PY - 2006/10/17/accepted PY - 2007/3/27/pubmed PY - 2007/9/21/medline PY - 2007/3/27/entrez SP - 624 EP - 32 JF - Gastrointestinal endoscopy JO - Gastrointest Endosc VL - 65 IS - 4 N2 - BACKGROUND: The prophylactic use of somatostatin or gabexate in patients undergoing ERCP is still controversial. OBJECTIVE: Our purpose was to update the meta-analysis on somatostatin (SS, 16 studies) or gabexate mesylate (GM, 9 studies) prophylaxis of post-ERCP pancreatitis and to run sensitivity analyses by subgrouping trials according to schedules of drug administration. MAIN OUTCOME MEASUREMENTS: Post-ERCP acute pancreatitis, hyperamylasemia, and pain. RESULTS: Heterogeneity was present among selected studies, which appeared eliminated when only 9 high-quality trials on SS and 5 randomized studies on GM were considered. After data were pooled from SS trials, pancreatitis occurred in 7.3% of controls versus 5.3% of treated patients, a nonsignificant effect (odds ratio [OR] = 0.73; 95% CI 0.54-1.006). The funnel plot showed asymmetry with a negative slope (P = .05). The meta-analysis produced negative results for either short- (<6 hours) or long-term (> or =12 hours) SS infusion, whereas a bolus injection proved effective (OR = 0.271; 95% CI 0.138-0.536), with a pooled absolute risk reduction of 8.2% (95% CI 4.4-12.0%). Postprocedural hyperamylasemia, but not pain, was significantly reduced (OR = 0.67, 95% CI 0.57-0.81). In controls and patients treated with GM, pancreatitis developed in 5.7% versus 4.8%, hyperamylasemia in 40.6% versus 36.9%, and pain in 1.7% versus 8.9%. All pooled ORs were nonsignificant: P = .34, .17, and .19, respectively. The meta-analysis produced no significant effect for either short-term (<6 hours) or long-term (>12 hours) GM administration. CONCLUSION: Short- or long-term infusion of SS or GM proved ineffective in reducing post-ERCP pancreatitis and pain. The beneficial effect of SS on postprocedural hyperamylasemia seems of marginal significance. When given as a bolus injection, SS maintains its promise in this field, but additional data are needed. SN - 0016-5107 UR - https://www.unboundmedicine.com/medline/citation/17383459/Prophylactic_administration_of_somatostatin_or_gabexate_does_not_prevent_pancreatitis_after_ERCP:_an_updated_meta_analysis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016-5107(06)03134-8 DB - PRIME DP - Unbound Medicine ER -