Rashid Mohammed Y, Noor Asfa, Patel Viral, Henin Shereen, Cuello-Ramírez Alejandrina, Al Kaabi Anoud S, Gnawali Anupa, Mostafa Jihan A
General Surgery, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
Cureus. 2021 Mar 5;13(3):e13724. doi: 10.7759/cureus.13724.
Acute pancreatitis is the most common iatrogenic dilemma of endoscopic retrograde cholangiopancreatography, and it is associated with significant morbidity and mortality. Several factors have been implicated in the pathogenesis of post-endoscopic retrograde cholangiopancreatography pancreatitis, and preventive measures were practiced accordingly. This study aims to refine the potential mechanisms that trigger post-endoscopic retrograde cholangiopancreatography pancreatitis and define the role of enteropeptidase in the pathogenesis of post-endoscopic retrograde cholangiopancreatography pancreatitis. Furthermore, address the role of a new novel medication known as SCO-792, a potent enteropeptidase inhibitor, in the prevention of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. Post-endoscopic retrograde cholangiopancreatography pancreatitis is caused by premature activation of the pancreatic enzymes within the pancreatic parenchyma. This activation is either an autoactivation due to direct provocation of intra-acinar enzymes as a result of the procedure or due to activation by enterpeptidase, a rate-limiting enzyme. Endoscopic retrograde cholangiopancreatography interjects duodenal juice that is rich in enterokinase into the pancreatic-biliary tract, which in turn leads to intra-ductal activation of trypsinogen and subsequent enzymes. Given the vital role of enterokinase in initiating the pathogenesis of pancreatitis, enteropeptidase inhibition may prevent and reduce the severity of post-endoscopic retrograde cholangiopancreatography pancreatitis. SCO-792, a novel enteropeptidase inhibitor, is developed by SCOHIA Pharma, and pre-clinical trials confirmed its efficacy in inhibiting enteropeptidase. Studies are needed to confirm the efficacy of enteropeptidase inhibitors in preventing post-endoscopic retrograde cholangiopancreatography pancreatitis.
急性胰腺炎是内镜逆行胰胆管造影最常见的医源性难题，且与显著的发病率和死亡率相关。内镜逆行胰胆管造影术后胰腺炎的发病机制涉及多个因素，并据此采取了预防措施。本研究旨在完善引发内镜逆行胰胆管造影术后胰腺炎的潜在机制，并确定肠肽酶在内镜逆行胰胆管造影术后胰腺炎发病机制中的作用。此外，探讨一种名为SCO-792的新型强效肠肽酶抑制剂在预防内镜逆行胰胆管造影（ERCP）术后胰腺炎中的作用。内镜逆行胰胆管造影术后胰腺炎是由胰腺实质内胰酶过早激活引起的。这种激活要么是由于操作直接刺激腺泡内酶导致的自身激活，要么是由于限速酶肠肽酶的激活。内镜逆行胰胆管造影将富含肠激酶的十二指肠液注入胰胆管，进而导致胰蛋白酶原及后续酶的导管内激活。鉴于肠激酶在胰腺炎发病机制起始过程中的关键作用，抑制肠肽酶可能预防并降低内镜逆行胰胆管造影术后胰腺炎的严重程度。SCO-792是SCOHIA制药公司研发的一种新型肠肽酶抑制剂，临床前试验证实了其抑制肠肽酶的功效。需要开展研究以确认肠肽酶抑制剂在预防内镜逆行胰胆管造影术后胰腺炎方面的疗效。
