Clinical Endoscopy

Role of vitamin C and rectal indomethacin in preventing and alleviating post-endoscopic retrograde cholangiopancreatography pancreatitis: a clinical study: Amir Sadeghi, Rana Jafari-Moghaddam, Sara Ataei, Mahboobe Asadiafrooz, Mohammad Abbasinazari; Clin Endosc 2023;56(2):214-220. Published online March 6, 2023; DOI: https://doi.org/10.5946/ce.2022.165

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Background
/Aims: This study aimed to determine whether vitamin C in addition to indomethacin decreases the occurrence and severity of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) occurrence and severity.
Methods
This randomized clinical trial included patients undergoing ERCP. The participants were administered either rectal indomethacin (100 mg) plus an injection of vitamin C (500 mg) or rectal indomethacin (100 mg) alone just before ERCP. The primary outcomes were PEP occurrence and severity. The secondary amylase and lipase levels were determined after 24 hours.
Results
A total of 344 patients completed the study. Based on intention-to-treat analysis, the PEP rates were 9.9% for indomethacin plus vitamin C plus indomethacin and 15.7% for indomethacin alone. Regarding the per-protocol analysis, the PEP rates were 9.7% and 15.7% in the combination and indomethacin arms, respectively. There was a remarkable difference between the two arms in PEP occurrence and severity on intention-to-treat and per-protocol analyses (p=0.034 and p=0.031, respectively). The post-ERCP lipase and amylase concentrations were lower in the combination arm than in the indomethacin alone arm (p=0.034 and p=0.029, respectively).
Conclusions
Vitamin C injection in addition to rectal indomethacin reduced PEP occurrence and severity.

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Effect of CoQ10 Addition to Rectal Indomethacin on Clinical Pancreatitis and Related Biomarkers in Post-endoscopic Retrograde Cholangiopancreatography
Saeed Abdi, Roja Qobadighadikolaei, Faezeh Jamali, Maryam Shahrokhi, Farzaneh Dastan, Mohammad Abbasinazari
Journal of Cellular & Molecular Anesthesia.2024;[Epub] CrossRef
Double-guidewire technique for selective biliary cannulation does not increase the rate of post-endoscopic retrograde cholangiopancreatography pancreatitis in patients with naïve papilla
Han Taek Jeong, June Hwa Bae, Ho Gak Kim, Jimin Han
Clinical Endoscopy.2024; 57(2): 226. CrossRef

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The Utility of Endoscopic Ultrasound in Patients with Isolated Elevations in Serum Amylase and/or Lipase: Lalitha M. Sitaraman, Amit H. Sachdev, Tamas A. Gonda, Amrita Sethi, John M. Poneros, Frank G. Gress; Clin Endosc 2019;52(2):175-181. Published online January 16, 2019; DOI: https://doi.org/10.5946/ce.2018.110

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Background
/Aims: The aim of this study was to describe the diagnostic yield of endoscopic ultrasound (EUS) in patients with isolated elevated levels of amylase and/or lipase.
Methods
A retrospective chart review was conducted at a large academic medical center from 2000 to 2016. Patients were selected based on having elevated amylase, lipase, or both, but without a diagnosis of pancreatitis or known pancreatobiliary disease. Patients were excluded if they had abnormal liver function tests or abnormal imaging of the pancreas.
Results
Of 299 EUS procedures performed, 38 met inclusion criteria. Symptoms were present in 31 patients, most frequently abdominal pain (87%). In 20 patients (53%), initial EUS most commonly found chronic pancreatitis (n=7; 18%), sludge (5; 13%), or new diagnosis of pancreas divisum (3; 8%). In the asymptomatic patients (7), 3 had a finding on EUS, most importantly sludge (2), stone (1), and pancreas divisum (1). No patients were diagnosed with a mass or pancreatic cyst. During the follow up period, 6 patients (22%) had cholecystectomy.
Conclusions
In our study of patients with isolated elevations in amylase and/or lipase without acute pancreatitis who underwent EUS, approximately 50% had a pancreatobiliary finding, most commonly chronic pancreatitis or biliary sludge.

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Endosonographic features in patients with non-alcoholic early chronic pancreatitis improved with treatment at one year follow up
Kazutoshi Higuchi, Seiji Futagami, Hiroshi Yamawaki, Makoto Murakami, Kumiko Kirita, Shuhei Agawa, Go Ikeda, Hiroto Noda, Yasuhiro Kodaka, Nobue Ueki, Keiko Kaneko, Katya Gudis, Ryuji Ohashi, Katsuhiko Iwakiri
Journal of Clinical Biochemistry and Nutrition.2021; 68(1): 86. CrossRef
Do Patients with Pancreatic Hyperenzymemia without Abnormal Imaging Need Additional Endoscopic Ultrasound?
Jung Wan Choe, Jong Jin Hyun
Clinical Endoscopy.2019; 52(2): 97. CrossRef

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내시경적 역행성 담췌관 조영술의 췌장 합병증 예방에 대한 Gabexate Mesilate의 유용성 ( Gabexate of the Prevention of Pancreatic Complication Follwing Endoscopic Retrograde Cholangiopancreatography ): Korean J Gastrointest Endosc 2000;21(3):730-734. Published online November 30, 1999

Abstract PDF: Background
/Aims: Gabexate, a protease inhibitor, has been known to prevent pancreatic damage following ERCP. We conducted a prospective and randomized study to assess the preventive effect of gabexate. Methods: Of the 96 patients enrolled, 46 were treated with gabexate and 50 with placebo. The groups were similar with regard to sex, age, body-mass index, and the final diagnosis of ERCP. Results: 24 patients (25.0%) had elevated pancreatic-enzyme levels; the frequency was similar in the two groups (P=0.48). Mean serum amylase value at 4 hours after ERCP was similar in patients with elevated basal level (220.5±43.2 U/L) and those with normal basal level (170.4±31.2 U/L). After the procedures, serum amylase values were lower in the gabexate group (137.1±19.8 U/L) than in the placebo group (212.0±50.4 U/L). The differences were not significant in the mean levels of amylase between the groups for any of imaging of the pancreatic ducts (pancreatic-duct imaging, 201.5±49.4 U/L, bile-duct imaging, 153.7±30.0 U/L). But in the patients with pancreatic duct imaging, serum amylase values were significantly higher in the placebo group (295.0±97.6 U/L) than in the gabexate group (112.0±10.6 U/L)(p<0.05). Conclusions: Prophylactic treatment witd gabexate does not reduce pancreatic damage related to ERCP, but only in the patients with pancreatic duct imaging there were the significant differences between in the gabexate group and in the placebo group.

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원저 : 내시경적 역행성 담췌관 조영술후 발생하는 고아밀라제혈증의 병인에 산소유리기의 역할 ( Original Articles : Role of Oxygen - Derived Free Radical in the ERCF - Induced Hyperamylasemia ): Korean J Gastrointest Endosc 1994;14(1):37-48. Published online November 30, 1993

Abstract PDF: There is growing evidence that oxygen-derived free radicals(OFR's) play a role in the pathogenesis of pancreatic diseases, especially of acute pancreatitis. Many types of experimental ex vivo and in vitro pancreatitis can be inhibited by superoxide dismutase and catalse. (continue...)

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