Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
J Clin Gastroenterol. 2011 Feb;45(2):170-6. doi: 10.1097/MCG.0b013e3181eb600e.
Efforts to prevent post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis have been largely unsuccessful. Cyclo-oxygenase-2 enzyme-mediated inflammatory pathway has been suggested in the pathophysiology of acute pancreatitis. Glyceryl trinitrate (GTN) might prevent post-ERCP pancreatitis by relaxing the sphincter of Oddi.
To evaluate the efficacy of valdecoxib, a cyclo-oxygenase-2 inhibitor, and GTN transdermal patch for the prevention of post-ERCP pancreatitis.
Patients undergoing first ERCP procedure from October 2003 to August 2005 were randomized to receive either 20 mg intravenous valdecoxib or GTN patch (10 mg/h) at the start of ERCP, or assigned to control group. The study followed CONSORT guidelines. Primary outcome measure was frequency of post-ERCP pancreatitis in the 3 groups.
A total of 380 patients were randomized; 121 patients in valdecoxib (group 1), 124 in GTN (group 2), and 126 in the control arm (group 3) were analyzed. There was no difference in the frequency of post-ERCP pancreatitis between the groups (12 each in groups 1 and 2, and 13 in group 3; P=0.986). None of the patients had severe pancreatitis. The frequency of post-ERCP pain and amylase levels were also similar in the 3 groups (P=0.769 and P=0.947, respectively). Pancreatic duct cannulation, cholecystectomy, difficult cannulation, and pre-cut were risk factors for pancreatitis on univariate analysis. On multivariate analysis, pancreatic duct cannulation was the only independent risk factor for pancreatitis (P≤0.001; odds ratio 5.67; 95% confidence interval: 2.76-11.63).
Valdecoxib and GTN were not effective for the prevention of post-ERCP pancreatitis.
预防内镜逆行胰胆管造影术（ERCP）后胰腺炎的努力基本没有成功。环氧化酶-2 酶介导的炎症途径已被提出用于急性胰腺炎的病理生理学。甘油三硝酸酯（GTN）通过放松 Oddi 括约肌可能预防 ERCP 后胰腺炎。
评估环氧化酶-2 抑制剂伐地考昔和 GTN 透皮贴剂预防 ERCP 后胰腺炎的疗效。
2003 年 10 月至 2005 年 8 月期间接受首次 ERCP 手术的患者随机分为静脉注射伐地考昔 20mg 组或 ERCP 开始时 GTN 贴剂（10mg/h）组，或分配至对照组。该研究遵循 CONSORT 指南。主要观察指标是 3 组中 ERCP 后胰腺炎的发生率。
共随机分配了 380 例患者；伐地考昔组（第 1 组）121 例，GTN 组（第 2 组）124 例，对照组（第 3 组）126 例。3 组间 ERCP 后胰腺炎的发生率无差异（第 1 组和第 2 组各 12 例，第 3 组 13 例；P=0.986）。没有患者发生严重胰腺炎。3 组间 ERCP 后疼痛和淀粉酶水平也相似（P=0.769 和 P=0.947）。胰管插管、胆囊切除术、困难插管和预切开是单因素分析中胰腺炎的危险因素。多因素分析显示，胰管插管是胰腺炎的唯一独立危险因素（P≤0.001；优势比 5.67；95%置信区间：2.76-11.63）。
伐地考昔和 GTN 对预防 ERCP 后胰腺炎无效。
