THE USE OF A LONG-ACTING SOMATOSTATIN ANALOG (OCTREOTIDE) FOR PROPHYLAXIS OF ACUTE-PANCREATITIS AFTER ENDOSCOPIC SPHINCTEROTOMY

Acute pancreatitis is a serious complication of endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (EST). I n addition, serum pancreatic enzymes increase without clinical symptom s in about 40-50% of patients undergoing these endoscopic procedures. We evaluated the potential of octreotide, a long-acting somatostatin a nalogue, to prevent these complications in patients who underwent EST for choledocholithiasis. 151 patients were randomly allocated to two g roups (A and B), Group A was given 0.1 mg of octreotide subcutaneously 120 and 30 min before EST and four hours after; group B was given a p lacebo. Serum amylases (normal range 20-220 IU/1) were measured before premedication and 4, 24, and 48 hours after the end of endoscopy. Aft er EST, the increase in the mean serum amylase was greater in the cont rol group, but the difference was statistically significant only at th e 48-hour measurement. There were five cases of acute pancreatitis in each group, with a trend (but not statistically significant) toward le ss severe pancreatitis in the treated group. In the control group, one patient with acute pancreatitis died. In conclusion, octreotide does not seem to prevent acute post-EST pancreatitis.