Tulassay Z, Döbrönte Z, Prónai L, Zágoni T, Juhász L
Semmelweis Medical University, Budapest, Hungary.
Aliment Pharmacol Ther. 1998 Nov;12(11):1109-12. doi: 10.1046/j.1365-2036.1998.00414.x.
Data on whether long-acting somatostatin analogue octreotide causes or prevents pancreatic injury following endoscopic retrograde cholangiopancreatography (ERCP) are controversial.
This multicentre, prospective trial studied the effect of octreotide on pancreatic injury in a large unselected group of patients after ERCP and endoscopic sphincterotomy.
The study was carried out in a prospective random manner on 2102 patients in 11 endoscopic centres. Patients in the study received 0.1 mg octreotide acetate and those in the control group received isotonic sodium chloride, subcutaneously before and 45 min after ERCP. Pancreatic injury was assessed by clinical symptoms such as pain, fever and abdominal tenderness. Serum amylase and blood sugar were determined prior to, and 6 and 24 h after the endoscopic procedure.
Data from 599 patients in the study group and 600 in the control group were included in the final evaluation. When all the patients were considered, octreotide did not induce pancreatic injury as assessed by clinical symptoms, and diminished the increase of serum amylase levels following ERCP. However, when subgroups of patients were studied, the frequency of increased amylase levels decreased significantly in patients with chronic obstructive pancreatitis and in patients who underwent endoscopic sphincterotomy (P < 0.01). The peak serum glucose level was higher in the treated group when compared to the controls.
The prophylactic use of long-acting somatostatin does not alter the frequency of post-ERCP pancreatic injury, but it may diminish the rate of increased serum amylase levels in patients with chronic obstructive pancreatitis and also in those with an endoscopic sphincterotomy.
长效生长抑素类似物奥曲肽是否会导致或预防内镜逆行胰胆管造影术（ERCP）后胰腺损伤的数据存在争议。
这项多中心前瞻性试验研究了奥曲肽对一大组未经选择的患者在ERCP和内镜括约肌切开术后胰腺损伤的影响。
该研究以前瞻性随机方式在11个内镜中心的2102例患者中进行。研究组患者在ERCP前及术后45分钟皮下注射0.1mg醋酸奥曲肽，对照组患者注射等渗氯化钠。通过疼痛、发热和腹部压痛等临床症状评估胰腺损伤。在内镜检查前、检查后6小时和24小时测定血清淀粉酶和血糖。
最终评估纳入了研究组599例患者和对照组600例患者的数据。当考虑所有患者时，根据临床症状评估，奥曲肽未诱发胰腺损伤，并减少了ERCP后血清淀粉酶水平的升高。然而，当对患者亚组进行研究时，慢性阻塞性胰腺炎患者和接受内镜括约肌切开术的患者中淀粉酶水平升高的频率显著降低（P<0.01）。与对照组相比，治疗组的血清葡萄糖峰值水平更高。
长效生长抑素的预防性使用不会改变ERCP后胰腺损伤的发生率，但可能会降低慢性阻塞性胰腺炎患者以及接受内镜括约肌切开术患者的血清淀粉酶水平升高率。
