Pharmacological prevention of post-ERCP pancreatitis: which therapy is best?
Pharmacological prevention of post-ERCP pancreatitis: which therapy is best?
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ERCP 术后胰腺炎的药物预防：哪种疗法最好？
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发表时间：
2003
期刊：
影响因子：
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通讯作者：
A. Mariani
中科院分区：
文献类型：
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作者：
A. Mariani
药物预防ERCP术后胰腺炎的有效性只能通过大型随机对照研究来确定。在过去的十年中，15项研究涉及这些特征，并对约3，000名非选择性患者进行了评估。累积安慰剂组的数据，ERCP后胰腺炎的中位发生率为8.7%（平均9.3%），范围为1.6%至17.7%，可能是由于病例混合和/或定义急性胰腺炎的不同标准。这些变量，而不是药物给药方式的差异，可以解释他们之间的对比研究的有效性。生长抑素和奥曲肽是最常试验的预防性药物（8项研究），其次是皮质类固醇，如氢化可的松、泼尼松或甲泼尼龙（4项研究）和加贝酯（3项研究）。虽然奥曲肽被证实是无效的，生长抑素和加贝酯似乎是最好的预防ERCP后胰腺炎，但都可以提出一些限制，如未报告的样本量计算的统计分析生长抑素研究和缺乏广泛的商业可用性加贝酯。英文文献中缺乏药物经济学研究。从这个角度来看，选择性预防似乎是合理的，而不是普遍的药物预防，但实际上，在高危患者中进行的实验性预治疗是无效的。
The effectiveness of the pharmacological prevention of post-ERCP pancreatitis can be established only from large controlled randomized studies. Over the last decade, fifteen studies dealt with these characteristics and a cumulative series of about 3,000 non-selected patients were evaluated. Cumulating the data of the placebo groups, the median incidence of post-ERCP pancreatitis was 8.7% (mean 9.3%), the range varied from 1.6 to 17.7% likely due to case mix and/or different criteria defining acute pancreatitis. These variables, other than differences in the modalities of the administration of the drugs, could explain their contrasting effectiveness between the studies. Somatostatin and octreotide were the prophylactic drugs more frequently experimented (8 studies) followed by corticosteroids such as hydrocortisone, prednisone or methylprednisolone (four studies) and gabexate (three studies). While octreotide was confirmed to be ineffective, somatostatin and gabexate seem to be the best for the prevention of post-ERCP pancreatitis, but both can present some limits such as unreported sample size calculation in the statistical analysis for somatostatin studies and lack of widespread commercial availability for gabexate. Pharmacoeconomic studies are lacking in English language literature. On this point of view, it seems reasonable and preferable a selective as opposed to universal pharmacological prophylaxis but, actually, the experimented pre-treatments in high-risk patients are ineffective.