Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA; Division of Pediatric Gastroenterology, Hepatology & Nutrition, Lucille Packard Children's Hospital at Stanford, Stanford, CA, USA.
Division of Pediatric Gastroenterology, Hepatology & Nutrition, Lucille Packard Children's Hospital at Stanford, Stanford, CA, USA.
Pancreatology. 2022 Sep;22(6):678-682. doi: 10.1016/j.pan.2022.07.003. Epub 2022 Jul 13.
Endoscopic retrograde cholangiopancreatography (ERCP) is commonly performed for the management of pancreaticobiliary disorders. The most troublesome ERCP-associated adverse event is post-ERCP pancreatitis (PEP), which occurs in up to 15% of all patients undergoing ERCP. A substantial body of preclinical data support a mechanistic rationale for calcineurin inhibitors in preventing PEP. The findings are coupled with recent clinical data suggesting lower rates of PEP in patients who concurrently use the calcineurin inhibitor tacrolimus (e.g., solid organ transplant recipients). In this review, we will firstly summarize data in support of testing the use of tacrolimus for PEP prophylaxis, either in combination with rectal indomethacin or by itself. Secondly, we propose that administering tacrolimus through the rectal route could be favorable for PEP prophylaxis over other routes of administration.
内镜逆行胰胆管造影术（ERCP）常用于治疗胰胆系统疾病。ERCP 相关的最麻烦的不良事件是 ERCP 后胰腺炎（PEP），约 15%接受 ERCP 的患者会发生。大量临床前数据支持钙调神经磷酸酶抑制剂预防 PEP 的机制原理。这些发现与最近的临床数据相结合，提示在同时使用钙调神经磷酸酶抑制剂他克莫司（例如实体器官移植受者）的患者中，PEP 的发生率较低。在这篇综述中，我们首先总结支持测试他克莫司用于 PEP 预防的临床数据，无论是与直肠吲哚美辛联合使用还是单独使用。其次，我们提出通过直肠途径给予他克莫司可能比其他给药途径更有利于 PEP 的预防。
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