Antisecretory vs. antiproteasic drugs in the prevention of post-ERCP pancreatitis: the evidence-based medicine derived from a meta-analysis study.

摘要: Uncertainties still exist about the clinical benefit of pharmacological prevention post-ERCP pancreatitis by either antisecretory drugs such as somatostatin and its long-acting analogue octreotide, or protease inhibitors gabexate mesilate. Recent, large-scale prospective studies have reported a fourfold reduction in acute compared to placebo with prophylactic administration mesilate somatostatin, whereas octreotide was found be ineffective. An initial meta-analysis all available controlled trials on this topic has confirmed these findings. The indiscriminate use patients is unlikely cost-effective, but selective prophylaxis for high-risk might advocated. Moreover, inasmuch 85% complications developed within 4 6 hours completing ERCP, it would reasonable infuse only limited length time. A recent trial, carried out highrisk patients, surprisingly documented higher incidence, although non-significant one, who received short-term than those given placebo: 11.5% 8.1% vs. 6.5%, respectively. In order explore discrepancy, original updated including data negative trial: heterogeneity among apparent. careful scrutiny most revealed differences patient population, protocols drug administration, technique operator-related risk factors trials, which could explain, themselves, contrasting results interventional studies. conclusion, current literature does not support ERCP-related pancreatic damage, even deemed at high complications. At present, (and pancreatitis) can prevented efficaciously appropriate selection mastering operator competence.