Bordas J M, Toledo-Pimentel V, Llach J, Elena M, Mondelo F, Ginès A, Terés J
Gastrointestinal Endoscopy Section, Hospital Clinic I Provincial, University of Barcelona, Spain.
Gastrointest Endosc. 1998 Mar;47(3):230-4. doi: 10.1016/s0016-5107(98)70318-9.
Pancreatitis is a potential problem in patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). Natural somatostatin reduces pancreatic secretion and has been administered in acute pancreatitis. To establish whether an injection of a single "bolus" of natural somatostatin is useful in preventing pancreatic reactions after endoscopic pancreatography, a randomized study was carried out in 160 patients undergoing pancreatography, associated or not, with endoscopic sphincterotomy.
Pancreatitis was considered to be present when there was the simultaneous appearance of serum amylase above 600 IU/mL and serum lipase above 200 IU, upper abdominal pain with tenderness, nausea and/or vomiting, and associated ileus, not completely resolved within 18 hours after the procedure and prolonging hospital stay.
The incidence of pancreatitis (10% vs. 2.5%, p < 0.05) was higher in the placebo group than in the somatostatin-treated group. The difference in frequency of pancreatitis was statistically significant (18% vs 0%, p < 0.05) in the ERCP plus sphincterotomy subgroup but not significant (6% versus 4%) in the ERCP subgroup.
These results suggest that the administration of a single bolus injection of natural somatostatin just before cannulation of the papilla may be useful in preventing pancreatitis. This procedure is useful in patients undergoing sphincterotomy. Further studies should be performed to determine whether this drug is useful in cases in which cannulation of the papilla is difficult or when therapeutic procedures require prolonged and/or aggressive manipulation of the papilla.
胰腺炎是接受内镜逆行胰胆管造影术（ERCP）患者的一个潜在问题。天然生长抑素可减少胰腺分泌，已用于治疗急性胰腺炎。为确定在内镜胰腺造影术前注射单次“大剂量”天然生长抑素是否有助于预防胰腺不良反应，对160例接受胰腺造影术（无论是否联合内镜括约肌切开术）的患者进行了一项随机研究。
当血清淀粉酶高于600 IU/mL且血清脂肪酶高于200 IU，同时出现上腹部疼痛伴压痛、恶心和/或呕吐以及相关肠梗阻，且在术后18小时内未完全缓解并延长住院时间时，即认为发生了胰腺炎。
安慰剂组胰腺炎的发生率（10%对2.5%，p<0.05）高于生长抑素治疗组。在ERCP加括约肌切开术亚组中，胰腺炎发生频率的差异具有统计学意义（18%对0%，p<0.05），但在ERCP亚组中差异无统计学意义（6%对4%）。
这些结果表明，在乳头插管前单次注射天然生长抑素可能有助于预防胰腺炎。该方法对接受括约肌切开术的患者有用。应进一步开展研究，以确定该药物在乳头插管困难或治疗操作需要对乳头进行长时间和/或积极操作的情况下是否有用。
