Testoni P A, Lella F, Bagnolo F, Buizza M, Colombo E
Istituto di Medicina Interna, Università degli Studi di Milano, Italy.
Ital J Gastroenterol. 1994 Dec;26(9):431-6.
Pancreatic reaction after endoscopic papillosphincterotomy (EPT) is a common event occurring in about 70% of cases. Acute pancreatitis may also develop in 1%-6% of cases. Previous attempts to prevent this reaction with an inhibitor of exocrine pancreatic secretion such as somatostatin provided conflicting results. The somatostatin long-acting analogue octreotide has recently proposed for the prevention of ERCP/EPT-induced pancreatic reaction. Therefore we tested the prophylactic effect of a subcutaneous administration of octreotide in two different dosages in 60 consecutive patients undergoing EPT for common bile duct stones and benign papillary stenosis. They were given either octreotide 0.2 mg (20 cases), or octreotide 0.1 mg (20 cases), or placebo (20 cases) before the procedure. Serum amylase levels were determined at baseline and 2, 4, 8 and 24 hours thereafter. The differences were statistically significant at 2 hours between subjects pretreated with octreotide 0.2 mg and control subjects (p = 0.01); at 4 and 8 hours after the procedure between both octreotide-treated groups and control subjects (octreotide 0.1 mg: p < 0.05, at 4 and 8 hrs; octreotide 0.2 mg: p = 0.01, at 4 hrs, and p < 0.01, at 8 hrs). In patients with previous episodes of relapsing pancreatitis, the increase in serum amylase was significantly reduced in the octreotide 0.2 mg group vs control group, at 4 hrs (p < 0.05) and 8 hrs (p < 0.05). Our data suggest that octreotide 0.2 mg has a greater prophylactic efficacy than 0.1 mg in reducing pancreatic reaction after EPT.
内镜下乳头括约肌切开术（EPT）后的胰腺反应是常见事件，约70%的病例会出现。1%-6%的病例还可能发展为急性胰腺炎。以往尝试用外分泌性胰腺分泌抑制剂（如生长抑素）预防这种反应，结果相互矛盾。生长抑素长效类似物奥曲肽最近被提议用于预防ERCP/EPT引起的胰腺反应。因此，我们在60例因胆总管结石和良性乳头狭窄接受EPT的连续患者中，测试了两种不同剂量皮下注射奥曲肽的预防效果。在手术前，他们分别接受奥曲肽0.2毫克（20例）、奥曲肽0.1毫克（20例）或安慰剂（20例）。在基线以及之后的2、4、8和24小时测定血清淀粉酶水平。接受0.2毫克奥曲肽预处理的受试者与对照组在2小时时差异有统计学意义（p = 0.01）；在手术后4和8小时，两个奥曲肽治疗组与对照组之间均有差异（奥曲肽0.1毫克：在4和8小时时p < 0.05；奥曲肽0.2毫克：在4小时时p = 0.01，在8小时时p < 0.01）。在既往有复发性胰腺炎发作的患者中，奥曲肽0.2毫克组与对照组相比，在4小时（p < 0.05）和8小时（p < 0.05）时血清淀粉酶的升高明显降低。我们的数据表明，在降低EPT后胰腺反应方面，0.2毫克奥曲肽比0.1毫克具有更大的预防效果。
