Arcidiacono R, Gambitta P, Rossi A, Grosso C, Bini M, Zanasi G
Department of Gastroenterology, Niguarda Hospital, Milan, Italy.
Endoscopy. 1994 Nov;26(9):715-8. doi: 10.1055/s-2007-1009081.
Acute pancreatitis is a serious complication of endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (EST). In addition, serum pancreatic enzymes increase without clinical symptoms in about 40-50% of patients undergoing these endoscopic procedures. We evaluated the potential of octreotide, a long-acting somatostatin analogue, to prevent these complications in patients who underwent EST for choledocholithiasis. 151 patients were randomly allocated to two groups (A and B). Group A was given 0.1 mg of octreotide subcutaneously 120 and 30 min before EST and four hours after; group B was given a placebo. Serum amylases (normal range 20-220 IU/l) were measured before premedication and 4, 24, and 48 hours after the end of endoscopy. After EST, the increase in the mean serum amylase was greater in the control group, but the difference was statistically significant only at the 48-hour measurement. There were five cases of acute pancreatitis in each group, with a trend (but not statistically significant) toward less severe pancreatitis in the treated group. In the control group, one patient with acute pancreatitis died. In conclusion, octreotide does not seem to prevent acute post-EST pancreatitis.
急性胰腺炎是内镜逆行胰胆管造影术（ERCP）和内镜括约肌切开术（EST）的一种严重并发症。此外，在接受这些内镜检查的患者中，约40% - 50%的患者血清胰酶升高但无临床症状。我们评估了长效生长抑素类似物奥曲肽在接受EST治疗胆总管结石的患者中预防这些并发症的潜力。151例患者被随机分为两组（A组和B组）。A组在EST前120分钟和30分钟以及术后4小时皮下注射0.1毫克奥曲肽；B组给予安慰剂。在内镜检查前用药前以及内镜检查结束后4小时、24小时和48小时测量血清淀粉酶（正常范围20 - 220 IU/l）。EST后，对照组血清淀粉酶的平均升高幅度更大，但仅在48小时测量时差异具有统计学意义。每组有5例急性胰腺炎病例，治疗组胰腺炎的严重程度有减轻的趋势（但无统计学意义）。在对照组中，1例急性胰腺炎患者死亡。总之，奥曲肽似乎不能预防EST术后急性胰腺炎。
