Use of corticosteroids in the prevention of post-ERCP pancreatitis: Results of a controlled prospective study

OBJECTIVE: The aim of this prospective controlled study was to determine wh ether prophylactic corticosteroids decrease the incidence of post-ERCP panc reatitis. METHODS: A double-blind comparison of hydrocortisone (100 mg by i.v. infusi on immediately before endoscopy) with placebo (sodium chloride administered in the same fashion). A total of 535 patients (286 women and 249 men, with an average age of 58.6 yr) who were scheduled to undergo diagnostic or ope rative ERCP underwent randomization. Six patients were excluded from the fi nal evaluation for various reasons. The remaining 529 patients, 263 in the hydrocortisone group and 266 in the placebo group, were analyzed. Patients were divided into subgroups with regard to high risk factors for acute panc reatitis after ERCP. RESULTS: The overall incidence of acute pancreatitis was 5.3% (28 of 529 pa tients). Procedure-induced pancreatitis occurred in 15 of 263 (5.7%) patien ts treated with hydrocortisone and in 13 of 266 (4.9%) patients treated wit h placebo (p = NS). The results of analysis of risk factors for pancreatiti s did not evidence any significant difference between the hydrocortisone gr oup and the placebo group. CONCLUSIONS: Hydrocortisone does not prevent acute pancreatitis after diagn ostic or therapeutic ERCP. (C) 1999 by Am. Cell. of Gastroenterology.