Octreotide in the prevention of pancreatic injury associated with endoscopic cholangiopancreatography.

Background: Data on whether long-acting somatostatin analogue octreotide ca uses or prevents pancreatic injury following endoscopic retrograde cholangi opancreatography (ERCP) are controversial, Aim: This multicentre, prospective trial studied the effect of octreotide o n pancreatic injury in a large unselected group of patients after ERCP and endoscopic sphincterotomy, Methods: The study was carried out in a prospective random manner on 2102 p atients in 11 endoscopic centres, Patients in the study received 0.1 mg oct reotide acetate and those in the control group received isotonic sodium chl oride, subcutaneously before and 45 min after ERCP. Pancreatic injury was a ssessed by clinical symptoms such as pain, fever and abdominal tenderness. Serum amylase and blood sugar were determined prior to, and 6 and 24 h afte r the endoscopic procedure. Results: Data from 599 patients in the study group and 600 in the control g roup were included in the final evaluation, When all the patients were cons idered, octreotide did not induce pancreatic injury as assessed by clinical symptoms, and diminished the increase of serum amylase levels following ER CP, However, when subgroups of patients were studied, the frequency of incr eased amylase levels decreased significantly in patients with chronic obstr uctive pancreatitis and in patients who underwent endoscopic sphincterotomy (P < 0.01), The peak serum glucose level was higher in the treated group w hen compared to the controls. Conclusion: 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 pan creatitis and also in those with an endoscopic sphincterotomy.