LONG-TERM PROPHYLACTIC ADMINISTRATION OF OCTREOTIDE REDUCES THE RISE IN SERUM AMYLASE AFTER ENDOSCOPIC PROCEDURES ON VATERS PAPILLA

The pancreas commonly reacts to endoscopic papillosphincterotomy (EST) with a rise in serum amylase, and acute pancreatitis may also develop . The long-acting somatostatin analogue octreotide has recently been p roposed for prevention of colangiopancreatography (ERCP)/EST-induced p ancreatic reaction. Therefore, we tested the prophylactic effects of a subcutaneous 3-day administration of octreotide to 60 consecutive pat ients undergoing ERCP and EST. They were randomly allocated to receive either 200 mu g octreotide t.i.d. for 3 days (30 cases) or placebo (c ontrol group, 30 cases) before the procedure. On the day of the examin ation, serum amylase levels were determined at baseline and 2, 4, 8, a nd 24 h thereafter. In the patients as a whole, the increases were sta tistically significant at 4 h (p < 0.01) and 8 h (p < 0.01). Epigastri c pain occurred in 2 patients in the octreotide group and in 13 contro l subjects (p < 0.001). Even in some patients who had had previous epi sodes of relapsing pancreatitis, the rise in serum amylase was signifi cantly lower in the octreotide group than in the control group at 4 h (p < 0.01), 8 h (p = 0.05), and 24 h (p = 0.05). Our data suggest that 3 days of prophylactic treatment with octreotide is effective for red ucing the rise in serum amylase after EST/ERCP and could be proposed f or patients with relapsing pancreatitis and other risk conditions befo re the Vater's papilla manipulation.