Original Article
Gabexate for the Prevention of Pancreatic Damage Related to Endoscopic Retrograde Cholangiopancreatography
N Engl J Med 1996; 335:919-923September 26, 1996
- Abstract
Background
Endoscopic retrograde cholangiopancreatography (ERCP) is associated with elevated levels of pancreatic enzymes and pancreatitis. Gabexate, a protease inhibitor, has been used to prevent pancreatic damage related to ERCP.
Methods
We conducted a multicenter, double-blind comparison of gabexate (1 g given by intravenous infusion starting 30 to 90 minutes before endoscopy and continuing for 12 hours afterward) with placebo (mannitol and sodium chloride, administered in the same fashion). A total of 435 adults scheduled to undergo ERCP and, when indicated, endoscopic sphincterotomy underwent randomization; 17 were excluded from the final analysis for various reasons. The remaining 418 patients (mean age, 60.4 years) — 208 in the gabexate group and 210 in the placebo group — were analyzed. Acute pancreatitis was considered to be present if serum amylase or lipase levels (or both) were five times greater than the upper limits of normal in association with the onset of pancreatic pain.
Results
After the procedures, 276 patients (66 percent) had elevated pancreatic-enzyme levels; the frequency was similar in the two groups. Mean serum amylase values were higher in the placebo group than in the gabexate group through 24 hours of observation (P = 0.03). Twelve patients in the gabexate group and 29 in the placebo group had abdominal pain (6 percent vs. 14 percent, P = 0.009). Sixteen patients in the placebo group and five in the gabexate group had acute pancreatitis (8 percent vs. 2 percent, P = 0.03). Two patients treated with gabexate and six given placebo had adverse events, all of which resolved. Two patients given placebo died of acute pancreatitis; one was excluded from the evaluation because pancreatitis was present before endoscopy. One patient in the gabexate group died, from a myocardial infarction.
Conclusions
Prophylactic treatment with gabexate reduced pancreatic damage related to ERCP, as reflected by reductions in the extent but not the frequency of elevated enzyme levels and in the frequency of pancreatic pain and acute pancreatitis.
Media in This Article
Figure 1
Mean (+SE) Serum Amylase Levels before and after Endoscopic Procedures in Patients Treated with Gabexate (N = 207) or Placebo (N = 208).Table 1
Base-Line Characteristics of the 418 Patients.Article Activity
- Article
Endoscopic retrograde cholangiopancreatography (ERCP) is used to diagnose and treat diseases affecting the biliary and pancreatic tracts. Manipulation of the papilla of Vater, however, is associated with serum pancreatic-enzyme elevations in up to 70 percent of patients and with acute pancreatitis, which may be fatal in some instances.1-6 Attempts to prevent these complications with aprotinin,7 glucagon,7,8 calcitonin,9 nifedipine,10 naturally occurring somatostatin,11-14 and more recently, octreotide15-17 have been disappointing.
Gabexate (ethyl-guanidine-hexanoil-oxy-dibenzoate-methyl-sodium-sulfonate) is a synthetic compound of 417 daltons that is not antigenic18 and diffuses easily. When administered by continuous intravenous infusion, gabexate reaches a steady state within 15 minutes, with a half-life of 55 seconds,19 and is eliminated in inactive form by the kidney. Gabexate is a protease inhibitor, with effects on trypsin, kallikrein, and plasmin, even when bound to alpha2-macroglobulin; on thrombin, even in the absence of antithrombin III; and on phospholipase A2 and C1 esterase.18 In animals it prevents acute pancreatitis induced by various means.20-23 In Japan, gabexate has been used as prophylaxis against serum pancreatic-enzyme elevations20,24,25 and acute pancreatitis26,27 after endoscopic procedures. In these and other studies of the treatment of hyperenzymemia28,29 and acute pancreatitis,30,31 there were no serious side effects, even when the medication was given at high doses. We conducted a multicenter placebo-controlled trial to assess the ability of gabexate to prevent pancreatic damage due to endoscopic and therapeutic maneuvers involving the papilla of Vater.
Methods
Patients
This study was conducted in 17 digestive-endoscopy centers in Italy from July 1993 to October 1994. The study group consisted of patients over 18 years of age who were scheduled to undergo ERCP and, when indicated, endoscopic sphincterotomy (Table 1Table 1
Base-Line Characteristics of the 418 Patients.). Exclusion criteria included active acute pancreatitis, chronic pancreatitis, pancreatic cancer, or cancer of the papilla of Vater. Patients with severe systemic diseases with possible secondary involvement of the pancreas or bile ducts were excluded, as were those being treated with drugs potentially capable of damaging the pancreas. Women of childbearing age, breast-feeding mothers, and women who were not using adequate contraception were also excluded. A total of 435 consecutive patients (236 women and 199 men; mean [±SD] age, 60±23 years) scheduled to undergo ERCP, endoscopic sphincterotomy of Oddi's sphincter, or both were recruited. All patients gave written informed consent before study entry. The study was approved by the ethics committee at each center. Data are not available on screened patients who did not meet the entry criteria.Study Design
A thorough clinical history was elicited from all patients enrolled in the study, and the reasons for the endoscopic examination were emphasized. For each patient, 10 identical-appearing vials that contained 100 mg of gabexate (Foy, Lepetit, Lainate, Italy) or placebo (mannitol and sodium chloride) were packaged according to a centralized randomization schedule. The contents of all 10 vials (total dose, 1 g) were dissolved in 500 ml of a 0.9 percent saline solution or a 5 percent glucose solution and administered by continuous intravenous infusion beginning 30 to 90 minutes before the endoscopy session and continuing for 12 hours afterward. Patients and physicians were unaware of the treatment assignments. Therapy with antibiotics, analgesics, and sedatives was allowed, whereas concomitant therapy with aprotinin, somatostatin, or octreotide or major morphine or morphine-like analgesics was a reason for exclusion. Benzodiazepines, spasmolytic agents, and atropine, alone or in combination, were allowed for premedication. All patients began fasting at midnight on the day before the examination. The contrast medium used during the endoscopic maneuvers was iopamidol (Iopamir, Bracco, Milan, Italy), a low-osmolality, non-ionic substance. At the end of the session, the endoscopist recorded the details of the endoscopic maneuver performed (including procedures such as endoscopic sphincterotomy), the ease or difficulty of cannulating the papilla of Vater, the appearance of the pancreatic duct (i.e., whether it was opacified), and the results of parenchymographic radiologic imaging, if performed. After endoscopy, patients fasted for at least eight hours. Serum amylase and lipase were measured before endoscopy and 4, 8, 12, and 24 hours afterward. The presence of abdominal pain attributable to the pancreas and the use and type of analgesic therapy were also recorded at these times. Ultrasonography was performed when pain occurred or when serum enzyme levels were five times higher than normal. If ultrasonography failed to detect abnormalities or foci of necrosis or peripancreatic collections were present, abdominal computed tomography was performed.
Definitions
Hyperenzymemia was defined as an elevation of serum amylase or lipase levels (or both) above the upper limits of normal if basal enzyme levels were normal or as any further elevation in these enzymes if basal enzyme levels exceeded the upper limits of normal. The peak value was the highest level of amylase or lipase recorded at any time. Pancreatic pain was defined as persistent pain in the epigastrium and periumbilical region and often radiating to the back. Acute pancreatitis was considered to be present if serum amylase or lipase levels (or both) were five times greater than the upper limits of normal in association with the onset of pancreatic pain. The study end points were reductions in the incidence or extent of hyperenzymemia, pancreatic pain, and acute pancreatitis after ERCP.
Statistical Analysis
When appropriate we used the chi-square test (with Yates' correction) and Fisher's exact test for categorical comparisons of data. Serum amylase and lipase data were subjected to analysis of variance for split-plot design with repeated measures (SAS version 6.04, GLM program).
Results
Of the 435 patients enrolled, 215 were treated with gabexate and 220 with placebo. Seventeen patients (7 in the gabexate group and 10 in the placebo group) were subsequently excluded from the final evaluation for the following reasons: the examination was not performed (2 patients in the gabexate group and 3 in the placebo group), acute pancreatitis was present at the time of the examination (3 patients in the placebo group), concomitant treatment with octreotide was being administered (3 patients in the placebo group), and data were not complete (5 patients in the gabexate group and 1 in the placebo group). This left 418 patients, 208 in the gabexate group and 210 in the placebo group. The groups were similar with regard to sex, age, body-mass index (the weight in kilograms divided by the square of the height in meters), and indication for endoscopy (Table 1).
Frequency of Hyperenzymemia
Before ERCP, 328 patients (78 percent) had serum amylase or lipase concentrations (or both) within the upper limits of normal (163 in the gabexate group and 165 in the placebo group, P = 0.95) and 90 patients (22 percent) had elevated basal serum enzyme levels (45 in each group). After ERCP, 276 patients (66 percent) had hyperenzymemia. The frequency of hyperenzymemia was lower among patients with normal basal enzyme levels than among those with elevated levels (188 of 328 vs. 88 of 90 patients, or 57 percent vs. 98 percent; P<0.001). Hyperenzymemia was more common after imaging of the pancreatic ducts than after bile-duct imaging (162 of 234 vs. 101 of 167 patients, or 69 percent vs. 60 percent; P = 0.08). Hyperenzymemia followed 13 of the 17 unsuccessful procedures (76 percent). The frequency of hyperenzymemia was similar whether endoscopic sphincterotomy or only diagnostic procedures were performed (156 of 232 vs. 120 of 186 patients, or 67 percent vs. 65 percent; P = 0.63). The frequency of hyperenzymemia did not vary between the groups for any of the endoscopic maneuvers.
Degree of Hyperenzymemia
After ERCP, the mean (±SE) peak levels of amylase and lipase were similar in patients with normal basal enzyme levels and those with elevated basal levels (amylase, 650.2±69.9 and 777±140.5 U per liter, respectively; P = 0.43; lipase, 1190±196.2 and 1060±290.9 U per liter; P = 0.75). The addition of endoscopic sphincterotomy was not associated with a marked increase in enzyme levels above that associated with diagnostic maneuvers (amylase, 767±111 and 602±68.7 U per liter, respectively; P = 0.20; lipase, 1340±265 and 1013±209 U per liter; P = 0.34). After the procedures, serum amylase values were significantly higher in the placebo group than in the gabexate group through 24 hours of observation (P = 0.03) (Figure 1Figure 1
Mean (+SE) Serum Amylase Levels before and after Endoscopic Procedures in Patients Treated with Gabexate (N = 207) or Placebo (N = 208).). A similar pattern was observed for lipase (data not shown), but the differences were not significant (P = 0.09).Pain and Hyperenzymemia
Forty-one patients (10 percent) had abdominal pain after the procedure. The frequency was significantly higher in the placebo group than in the gabexate group (14 percent vs. 6 percent, P = 0.009) (Table 2Table 2
Incidence of Hyperenzymemia, Pain, and Acute Pancreatitis in the Treatment Groups.). Ninety percent of the patients with pain had hyperenzymemia (37 of 41), as compared with 63 percent of asymptomatic patients (239 of 377, P = 0.001). The mean peak amylase and lipase values were higher in the symptomatic patients than in the asymptomatic patients (amylase, 1861±340 vs. 546±56 U per liter; P<0.001). All 29 symptomatic patients in the placebo group had hyperenzymemia, as compared with 8 of the 12 in the gabexate group (67 percent, P = 0.004). Gabexate was not associated with any difference in the frequency of hyperenzymemia in asymptomatic patients (126 of 196 patients in the gabexate group vs. 113 of 181 patients in the placebo group, or 64 percent vs. 62 percent; P = 0.79). Pain was more frequent after pancreatic-duct imaging than after bile-duct imaging (33 of 234 vs. 7 of 167 patients, or 14 percent vs. 4 percent; P = 0.001). Pain was also more frequent after operative procedures than after diagnostic examination (24 of 186 vs. 17 of 232 patients, or 13 percent vs. 7 percent; P = 0.08).Acute Pancreatitis
The overall incidence of acute pancreatitis was 5 percent. Patients treated with gabexate had a lower incidence of acute pancreatitis than those given placebo (2 percent vs. 8 percent, P = 0.03) (Table 2). Endoscopies that included pancreatic-duct imaging were associated with acute pancreatitis in 6 percent of patients (15 of 234); in contrast, in endoscopies involving bile-duct imaging alone, only 3 percent of patients had pancreatitis (5 of 167, P = 0.18) (Table 3Table 3
Percentage of Patients with Acute Pancreatitis after Various Endoscopic Procedures.). The incidence of acute pancreatitis was similar after diagnostic procedures and procedures including sphincterotomy (5 percent vs. 5 percent, P = 0.94) (Table 3). The incidence of acute pancreatitis was similar among patients with normal basal enzyme levels and those with elevated levels (17 of 328 and 4 of 90 patients, respectively; 5 percent and 4 percent; P = 0.99).Acute pancreatitis was clinically mild and of the edematous type, as assessed by ultrasonography or computed tomography, in 16 of the 21 patients (76 percent) and of the necrotizing type in the remaining 5 patients (24 percent). All five patients with pancreatitis in the gabexate group had mild disease that resolved with only medical measures. By contrast, 5 of the 16 patients with acute pancreatitis in the placebo group had necrotizing pancreatitis. Three of these five patients had peripancreatic fluid collections, for which one required surgery and subsequently died of multiorgan failure on day 19.
Need for Analgesics, Ultrasonography, and Computed Tomography
More patients required analgesics in the placebo group than in the gabexate group (24 of 199 vs. 12 of 199 patients for whom information was available, or 12 percent vs. 6 percent; P = 0.05). Ultrasonography was performed in 54 patients in the placebo group as compared with 29 in the gabexate group (26 percent vs. 14 percent, P = 0.003). Seven patients in the placebo group and three in the gabexate group underwent computed tomography.
Adverse Events and Mortality
Eight patients — two in the gabexate group and six in the placebo group — had adverse events during the treatment. One of the patients in the gabexate group had mild nausea and vomiting, and the other had self-limiting dyspnea and a hypertensive crisis; all these effects resolved with no interruption of treatment. The six patients in the placebo group had eight adverse events: flushing in two, vomiting in three, hypotension in one, sweating in one, and malaise in one. Three patients died, two in the placebo group and one in the gabexate group. One patient in the placebo group died of acute pancreatitis, which was present before endoscopy, and was excluded from the final evaluation. Another patient in the placebo group, as discussed above, died 19 days after endoscopy of multiorgan failure due to acute pancreatitis. The patient in the gabexate group died of a myocardial infarction 14 days after endoscopy.
Discussion
Prophylactic treatment with gabexate reduced pancreatic damage related to endoscopic maneuvers involving the papilla of Vater, as reflected by reductions in the extent but not the frequency of hyperenzymemia and in the frequency of pain and acute pancreatitis. The incidences of hyperenzymemia, pain, and acute pancreatitis in particular in the placebo group — 68 percent, 14 percent, and 8 percent, respectively — are similar to those in other prospective studies.4,32 The incidence of adverse effects associated with endoscopic retrograde cholangiopancreatography was higher than that reported in a number of retrospective studies4; this difference may be attributable to a greater awareness of the problem and to better recording of data in prospective studies.2,4 Almost all the patients with elevated serum enzyme levels at base line had further increases in amylase, lipase, or both, but as reported previously,1 the extent of the increase and the frequency of acute pancreatitis were similar to those in patients with normal enzyme levels at base line. These data confirm the hypothesis1,33 that high initial pancreatic-enzyme levels are not necessarily a contraindication to endoscopy.
Treatment with gabexate did not lower the frequency of hyperenzymemia but did reduce the extent of the increase in enzyme levels. The pancreatic damage that ensues after manipulation of the papilla of Vater may be due to extraductal leakage of the pancreatic juice present in the ducts, traumatic rupture of a number of acinar units,1,2,4 or alterations of the acinar cells. Such functional alterations, caused by the temporary obstruction of the ducts, consist of a block in the normal cellular exocytosis of enzymes, which instead leak into the interstitium and then into the blood.34,35 As a protease inhibitor and a diffusable molecule, gabexate may help contain the increase in enzymes due to functional alterations of the acinar cell. Studies in rats20 have demonstrated that prophylactic administration of gabexate prevents alterations in intracellular transport and the elevation in serum amylase levels, probably by blocking an esterase involved in these changes. In our study, treatment with gabexate appeared to reduce not only the frequency and severity of the pain (as shown by the less frequent use of analgesics), but also the frequency of hyperenzymemia in symptomatic patients. It did not, however, affect the frequency of hyperenzymemia in people without pain. In conclusion, our results demonstrate that prophylactic administration of gabexate reduces the frequency of acute pancreatitis after operative and diagnostic endoscopic maneuvers on the papilla of Vater. Further studies are necessary to identify the patients at greatest risk for acute pancreatitis and to evaluate the cost effectiveness of this therapy.
This study was funded in part by Lepetit, Italy.
Source Information
From the Cattedra di Gastroenterologia, Università di Verona, Verona (G.C., L.F., V.D.F.); and Servizio di Gastroenterologia ed Endoscopia Digestiva, Ospedale S. Raffaele, Milan (A.T., E.M., A.M.) — both in Italy.
Address reprint requests to Dr. Cavallini at the Cattedra di Gastroenterologia, Policlinico Borgo Roma, via delle Menegone, 37134 Verona, Italy.
Members of the Gabexate in Digestive Endoscopy — Italian Group are listed in the Appendix.
Appendix
The members of the Gabexate in Digestive Endoscopy — Italian Group were as follows: G.P. Angelini and M.B. Casarini, Policlinico Borgo Roma, Verona; G. Bedogni and R. Conigliaro, Ospedale Santa Maria Nuova, Reggio Emilia; L. Bonardi and M.T.A. Khajekini, Presidio Sanitario Gradenigo, Torino; L. Cipolletta and M.A. Bianco, Ospedale Torre del Greco, Napoli; G. Costamagna and V. Perri, Policlinico Gemelli, Roma; G. Dobrilla and G. De Pretis, Ospedale Generale Regionale, Bolzano; L. Familiari and G. Giacobbe, Policlinico Universitario, Messina; A. Fratton and N. Carone, Ospedale Borgo Trento, Verona; P. Loriga and A. Muscas, Ospedale S. Maria della Trinità, Cagliari; F. Mazzeo and L. Gaeta, II Policlinico, Napoli; M. Miglioli and R. Pezzilli, Policlinico S. Orsola, Bologna; A. Morelli and L. Santucci, Policlinico Monteluce, Perugia; R. Naccarato and G. Del Favero, Ospedale Civile, Padova; F. Orlandi and G.P. Macarri, Università di Ancona, Ancona; A. Russo and C. Virgilio, Diagnostica e Chirurgia Endoscopica, Catania; and G. Uomo and G. Manes, Ospedale Cardarelli, Napoli.
- References
References
1
Skude G ,Wehlin L ,Maruyama T ,Ariyama J . Hyperamylasaemia after duodenoscopy and retrograde cholangiopancreatography. Gut 1976;17:127-132
CrossRef | Web of Science | Medline2
LaFerla G ,Gordon S ,Archibald M ,Murray WR . Hyperamylasaemia and acute pancreatitis following endoscopic retrograde cholangiopancreatography. Pancreas 1986;1:160-163
CrossRef | Medline3
Vaira D ,D'Anna L ,Ainley C , et al. Endoscopic sphincterotomy in 1000 consecutive patients. Lancet 1989;2:431-434
CrossRef | Web of Science | Medline4
Sherman S ,Lehman GA . ERCP- and endoscopic sphincterotomy-induced pancreatitis. Pancreas 1991;6:350-367[Erratum, Pancreas 1992;7:402.]
CrossRef | Web of Science | Medline5
Chen YK ,Foliente RL ,Santoro MJ ,Walter MH ,Collen MJ . Endoscopic sphincterotomy-induced pancreatitis: increased risk associated with nondilated bile ducts and sphincter of Oddi dysfunction. Am J Gastroenterol 1994;89:327-333
Web of Science | Medline6
Sherman S . ERCP and endoscopic sphincterotomy-induced pancreatitis. Am J Gastroenterol 1994;89:303-305
Web of Science | Medline7
Koch H ,Belohlavek D ,Schaffner O ,Tympner F ,Rosch W ,Demling L . Prospective study for the prevention of pancreatitis following endoscopic retrograde cholangio-pancreatography (ERCP). Endoscopy 1975;7:221-224
CrossRef | Web of Science8
Silvis SE ,Vennes GA . The role of glucagon in endoscopic cholangiopancreatography. Gastrointest Endosc 1975;21:162-163
CrossRef | Web of Science | Medline9
Odes HS ,Novis BN ,Barbezat GO ,Banks S . Effect of calcitonin on the serum amylase levels after endoscopic retrograde cholangiopancreatography. Digestion 1977;16:180-184
CrossRef | Web of Science | Medline10
Sand J ,Nordback I . Prospective randomized trial of the effect of nifedipine on pancreatic irritation after endoscopic retrograde cholangiopancreatography. Digestion 1993;54:105-111
CrossRef | Web of Science | Medline11
Borsch G ,Bergbauer M ,Nebel W ,Sabin G . Der Einfluss von Somatostatin auf die Amylasespiegel und Pankreatitisrate nach ERCP. Med Welt 1984;35:109-112
Web of Science | Medline12
Bordas JM ,Toledo V ,Mondelo F ,Rodes J . Prevention of pancreatic reactions by bolus somatostatin administration in patients undergoing endoscopic retrograde cholangio-pancreatography and endoscopic sphincterotomy. Horm Res 1988;29:106-108
CrossRef | Web of Science | Medline13
Saari A ,Kivilaakso E ,Shroder T . The influence of somatostatin on pancreatic irritation after pancreatography: an experimental and clinical study. Surg Res Commun 1988;24:271-27414
Testoni P ,Masci E ,Bagnolo F ,Tittobello A . Endoscopic papillosphincterotomy: prevention of pancreatic reaction by somatostatin. Ital J Gastroenterol 1988;20:70-7315
Binmoeller KF ,Harris AG ,Dumas R ,Grimaldi C ,Delmont JP . Does the somatostatin analogue octreotide protect against ERCP induced pancreatitis? Gut 1992;33:1129-1133
CrossRef | Web of Science | Medline16
Sternlieb JM ,Aronchick CA ,Retig JN , et al. A multicenter, randomized, controlled trial to evaluate the effect of prophylactic octreotide on ERCP-induced pancreatitis. Am J Gastroenterol 1992;87:1561-1566
Web of Science | Medline17
Arcidiacono R ,Gambitta P ,Rossi A ,Grosso C ,Bini M ,Zanasi G . The use of a long-acting somatostatin analogue (octreotide) for prophylaxis of acute pancreatitis after endoscopic sphincterotomy. Endoscopy 1994;26:715-718
CrossRef | Web of Science | Medline18
Tamura Y ,Hirado M ,Okamura K ,Minato Y ,Fujii S . Synthetic inhibitors of trypsin, plasmin, kallikrein, thrombin, C1r, and C1 esterase. Biochim Biophys Acta 1977;484:417-422
Web of Science | Medline19
Nishijima MK ,Takezawa J ,Taenaka N ,Shimada Y ,Yoshiya I . Application of HPLC measurement of plasma concentration of gabexate mesilate. Thromb Res 1983;31:279-284
CrossRef | Web of Science | Medline20
Ohshio G ,Saluja AK ,Leli U ,Sengupta A ,Steer ML . Esterase inhibitors prevent lysosomal enzyme redistribution in two noninvasive models of experimental pancreatitis. Gastroenterology 1989;96:853-859
Web of Science | Medline21
Niederau C ,Liddle RA ,Ferrell LD ,Grendell JH . Beneficial effects of cholecystokinin-receptor blockade and inhibition of proteolytic enzyme activity in experimental acute hemorrhagic pancreatitis in mice: evidence for cholecystokinin as a major factor in the development of acute pancreatitis. J Clin Invest 1986;78:1056-1063
CrossRef | Web of Science | Medline22
Wisner JR Jr ,Renner IG ,Grendell JH ,Niederau C ,Ferrell LD . Gabexate mesilate (FOY) protects against ceruletide-induced acute pancreatitis in the rat. Pancreas 1987;2:181-186
CrossRef | Web of Science | Medline23
Wakayama T ,Itoh T ,Shibayama K ,Idezuki Y . Prevention of the spread of experimental acute pancreatitis by intraductal administration of a synthetic inhibitor in dogs. Am J Gastroenterol 1989;84:272-278
Web of Science | Medline24
Kuno N ,Kasugai T ,Oguri T , et al. Study on prevention of complications associated with endoscopic retrograde cholangiopancreatography (ERCP): a controlled trial of a new protease inhibitor, Foy, in hyperamylasemia following endoscopic retrograde cholangiopancreatography. Gendai Iryo 1978;10:571-57125
Inada Y ,Yamada M ,Kadohara M , et al. The clinical study on the effect of Foy on complications following endoscopic retrograde cholangiopancreatography. Gendai Iryo 1980;12:1493-149326
Tsunashima T ,Kawai K ,Suwaki K , et al. Experience with Foy for the prevention of acute pancreatitis after ERCP. Gendai Iryo 1979;11:543-54327
Matsunaga E ,Sato J ,Nakashima H , et al. Effect of Foy on prevention of the occurrence of pancreatitis after ERCP. Gendai Iryo 1979;11:1213-121328
Salomon V, Kuntz HD, May B. Wirkung des synthetischen proteinase-inhibitors Foy auf die hyperamilasämie nach ERCP. In: Grozinger KH, Schrey A, Wabnitz RW, eds. Proteinasen inhibition, Foy workshop, Düsseldorf 1981. Munich, Germany: Wolf & Sohn, 1982:132-5.
29
Benini L ,Angelini G ,Lavarini E , et al. Effect of a new enzyme inhibitor (gabexate mesilate-FOY) on hyperenzymemia induced by ERCP: a double-blind study. Digestion 1985;32:165-165 abstract.
Web of Science30
Buchler M ,Malfertheiner P ,Uhl W . Gabexate mesilate in human acute pancreatitis. Gastroenterology 1993;104:1165-1170
Web of Science | Medline31
Pederzoli P ,Cavallini G ,Falconi M ,Bassi C . Gabexate mesilate vs aprotinin in human acute pancreatitis (GA.ME.P.A): a prospective, randomized, double-blind multicenter study. Int J Pancreatol 1993;14:117-124
Medline32
Sherman S ,Hawes RH ,Rathgaber SW , et al. Post-ERCP pancreatitis: randomized, prospective study comparing a low- and high-osmolality contrast agent. Gastrointest Endosc 1994;40:422-427
CrossRef | Web of Science | Medline33
Blackwood WD ,Vennes JA ,Silvis SE . Post-endoscopy pancreatitis and hyperamylasuria. Gastrointest Endosc 1973;20:56-58
CrossRef | Medline34
Saluja A ,Saluja M ,Villa A , et al. Pancreatic duct obstruction in rabbits causes digestive zymogen and lysosomal enzyme colocalization. J Clin Invest 1989;84:1260-1266
CrossRef | Web of Science | Medline35
Ohshio G ,Saluja A ,Steer ML . Effects of short-term pancreatic duct obstruction in rats. Gastroenterology 1991;100:196-202
Web of Science | Medline
- Citing Articles (122)
Citing Articles
1
Julia Mayerle, Annegret Dummer, Mathias Sendler, Sudarshan Ravi Malla, Cindy van den Brandt, Steffen Teller, Ali Aghdassi, Claudia Nitsche, Markus M Lerch. (2012) Differential roles of inflammatory cells in pancreatitis. Journal of Gastroenterology and Hepatology 27, 47-51
CrossRef2
Ignacio Neumann, Bruno Grassi, Fadi Bdair, Gabriel Rada, Ignacio Neumann. 2011. Antiproteases for acute pancreatitis. .
CrossRef3
Kee Tae Park, Dae Hwan Kang, Cheol Woong Choi, Mong Cho, Su Bum Park, Hyung Wook Kim, Dong Uk Kim, Chung Wook Chung, Ki Tae Yoon. (2011) Is High-Dose Nafamostat Mesilate Effective for the Prevention of Post-ERCP Pancreatitis, Especially in High-Risk Patients?. Pancreas 40:8, 1215-1219
CrossRef4
Yousuke Nakai, Hiroyuki Isayama, Takeshi Tsujino, Naoki Sasahira, Kenji Hirano, Hirofumi Kogure, Takashi Sasaki, Kazumichi Kawakubo, Hiroshi Yagioka, Yoko Yashima, Suguru Mizuno, Keisuke Yamamto, Toshihiko Arizumi, Osamu Togawa, Saburo Matsubara, Natsuyo Yamamoto, Minoru Tada, Masao Omata, Kazuhiko Koike. (2011) Impact of introduction of wire-guided cannulation in therapeutic biliary endoscopic retrograde cholangiopancreatography. Journal of Gastroenterology and Hepatology 26:10, 1552-1558
CrossRef5
Albert Pahk, Johanne Rigaux, Vijay Poreddy, Joan Smith, Firas Al-Kawas. (2011) Prophylactic Pancreatic Stents: Does Size Matter? A Comparison of 4-Fr and 5-Fr Stents in Reference to Post-ERCP Pancreatitis and Migration Rate. Digestive Diseases and Sciences 56:10, 3058-3064
CrossRef6
Jens Werner, Werner Hartwig, Thilo Hackert, Heiko Kaiser, Jan Schmidt, Martha M. Gebhard, Markus W. Büchler, Ernst Klar. (2011) Multidrug strategies are effective in the treatment of severe experimental pancreatitis. Surgery
CrossRef7
Paul S. Jowell, Malcolm S. Branch, Seymour H. Fein, Edward D. Purich, Rakhi Kilaru, Gail Robuck, Philip d'Almada, John Baillie. (2011) Intravenous Synthetic Secretin Reduces the Incidence of Pancreatitis Induced by Endoscopic Retrograde Cholangiopancreatography. Pancreas 40:4, 533-539
CrossRef8
Takeshi Seta, Yoshinori Noguchi. (2011) Protease inhibitors for preventing complications associated with ERCP: an updated meta-analysis. Gastrointestinal Endoscopy 73:4, 700-706.e2
CrossRef9
Kyo-Sang Yoo, Kyung Rim Huh, Yu Jin Kim, Kyoung Oh Kim, Cheol Hee Park, Taeho Hahn, Sang Hoon Park, Jong Hyeok Kim, Choong Kee Park, Young-Jun Kwon, Glen A. Lehman. (2011) Nafamostat Mesilate for Prevention of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis. Pancreas 40:2, 181-186
CrossRef10
Joo Won Chung, Jae Bock Chung. (2011) Endoscopic Papillary Balloon Dilation for Removal of Choledocholithiasis: Indications, Advantages, Complications, and Long-Term Follow-Up Results. Gut and Liver 5:1, 1
CrossRef11
Tooru SHIMOSEGAWA, Tetsuhide ITO, Ryuukichi AKASHI, Hisato IGARASHI, Shuji ISAJI, Kazuo INUI, Kazuichi OKAZAKI, Keisho KATAOKA, Terumi KAMISAWA, Shigeyuki KAWA, Motoji KITAGAWA, Yasuyuki KIHARA, Kyoko SHIMIZU, Keiko SHIRATORI, Kazunori TAKEDA, Yoshifumi TAKEYAMA, Satoru NARUSE, Isao NISHIMORI, Masahiko HIROTA, Morihisa HIROTA, Tomoki FURUYA, Atsushi MASAMUNE, Toshihiko MAYUMI, Tetsuya MINE. (2011) Consensus in initial management of acute pancreatitis (3rd Edition). Suizo 26:6, 651-683
CrossRef12
Fumio Omata, Gautam Deshpande, Yasuharu Tokuda, Osamu Takahashi, Sachiko Ohde, David L. Carr-Locke, Joshua L. Jacobs, Tetsuya Mine, Tsuguya Fukui. (2010) Meta-analysis: somatostatin or its long-acting analogue, octreotide, for prophylaxis against post-ERCP pancreatitis. Journal of Gastroenterology 45:8, 885-895
CrossRef13
Ryo Harada, Hirofumi Kawamoto, Hirotoshi Fukatsu, Hironari Kato, Ken Hirao, Naoko Kurihara, Osamu Mizuno, Tsuneyoshi Ogawa, Etsuji Ishida, Hiroyuki Okada, Kazuhide Yamamoto, Hiroshi Yamamoto. (2010) Nonprevention of Post-Endoscopic Retrograde Cholangiopancreatographic Pancreatitis by Pancreatic Stent After Aspiration of Pure Pancreatic Juice in Patients With Intraductal Papillary Mucinous Neoplasms of the Pancreas. Pancreas 39:3, 340-344
CrossRef14
Shinju Arata, Tadahiro Takada, Koichi Hirata, Masahiro Yoshida, Toshihiko Mayumi, Morihisa Hirota, Masamichi Yokoe, Masahiko Hirota, Seiki Kiriyama, Miho Sekimoto, Hodaka Amano, Keita Wada, Yasutoshi Kimura, Toshifumi Gabata, Kazunori Takeda, Keisho Kataoka, Tetsuhide Ito, Masao Tanaka. (2010) Post-ERCP pancreatitis. Journal of Hepato-Biliary-Pancreatic Sciences 17:1, 70-78
CrossRef15
Jaimie D. Nathan, Joelle Romac, Ruth Y. Peng, Michael Peyton, Don C. Rockey, Rodger A. Liddle. (2010) Protection Against Chronic Pancreatitis and Pancreatic Fibrosis in Mice Overexpressing Pancreatic Secretory Trypsin Inhibitor. Pancreas 39:1, e24-e30
CrossRef16
Joshua B. Colton, Colleen C. Curran. (2009) Quality indicators, including complications, of ERCP in a community setting: a prospective study. Gastrointestinal Endoscopy 70:3, 457-467
CrossRef17
Cheol Woong Choi, Dae Hwan Kang, Gwang Ha Kim, Jae Sup Eum, Sun Mi Lee, Geun Am Song, Dong Uk Kim, Il Doo Kim, Mong Cho. (2009) Nafamostat mesylate in the prevention of post-ERCP pancreatitis and risk factors for post-ERCP pancreatitis. Gastrointestinal Endoscopy 69:4, e11-e18
CrossRef18
Konosuke Nakaji, Shigeo Suzumura, Yukinori Nakae, Kensaku Kojima, Mitsutaka Kumamoto, Tomonaga Kozu. (2009) Effects in the Control of Edema of the Papilla of Vater by Epinephrine Saline Irrigation after Endoscopic Retrograde Cholangiopancreatography in an Endoscopy Center in Japan, 2003 to 2007: Exploratory Retrospective Analysis to Evaluate the Characteristics of Eligible Patients with a Focus on Serum Amylase Levels. Internal Medicine 48:12, 945-952
CrossRef19
Mitsunobu Matsushita, Hiroshi Takakuwa, Naoto Shimeno, Kazushige Uchida, Akiyoshi Nishio, Kazuichi Okazaki. (2009) Epinephrine sprayed on the papilla for prevention of post-ERCP pancreatitis. Journal of Gastroenterology 44:1, 71-75
CrossRef20
Jae Hyuck Chang, In Seok Lee, Hyung Keun Kim, Yu Kyung Cho, Jae Myung Park, Sang Woo Kim, Myung-Gyu Choi, In-Sik Chung. (2009) Nafamostat for Prophylaxis against Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis Compared with Gabexate. Gut and Liver 3:3, 205
CrossRef21
Ji Won Yoo, Ji Kon Ryu, Sang Hyub Lee, Sang Myung Woo, Joo Kyung Park, Won Jae Yoon, Jun Kyu Lee, Kwang Hyuck Lee, Jin-Hyeok Hwang, Yong-Tae Kim, Yong Bum Yoon. (2008) Preventive Effects of Ulinastatin on Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis in High-Risk Patients. Pancreas 37:4, 366-370
CrossRef22
Minghua Zheng, Yongping Chen, Jianling Bai, Yongning Xin, Xiazhen Pan, Lu Zhao. (2008) Meta-Analysis of Prophylactic Allopurinol Use in Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis. Pancreas 37:3, 247-253
CrossRef23
James A. DiSario. (2008) Endoscopic balloon dilation of the sphincter of Oddi for stone extraction in the elderly: is the juice worth the squeeze?. Gastrointestinal Endoscopy 68:3, 483-486
CrossRef24
O. Barkay, E. Niv, E. Santo, R. Bruck, A. Hallak, F. M. Konikoff. (2008) Low-dose heparin for the prevention of post-ERCP pancreatitis: a randomized placebo-controlled trial. Surgical Endoscopy 22:9, 1971-1976
CrossRef25
Mitchell S. Cappell. (2008) Acute Pancreatitis: Etiology, Clinical Presentation, Diagnosis, and Therapy. Medical Clinics of North America 92:4, 889-923
CrossRef26
Yun Ju Jo, Ho Soon Choi, Dae Won Jun, Oh Young Lee, Joo Seop Kang, Il Gyu Park, Kyung Hwan Jung, Joon Soo Hahm. (2008) The effects of a new human leukocyte elastase inhibitor (recombinant guamerin) on cerulein-induced pancreatitis in rats. International Immunopharmacology 8:7, 959-966
CrossRef27
Manouchehr Khoshbaten, Homayoun Khorram, Leili Madad, Mohammad Javad Ehsani Ardakani, Haleh Farzin, Mohammmad Reza Zali. (2008) Role of diclofenac in reducing post-endoscopic retrograde cholangiopancreatography pancreatitis. Journal of Gastroenterology and Hepatology 23:7pt2, e11-e16
CrossRef28
Tufan Haciahmetoglu, Cemalettin Ertekin, Kemal Dolay, Fatih Yanar, Hakan Yanar, Yersu Kapran. (2008) The effects of contrast agent and intraductal pressure changes on the development of pancreatitis in an ERCP model in rats. Langenbeck's Archives of Surgery 393:3, 367-372
CrossRef29
Joseph Romagnuolo, Robert Hilsden, Gurpal S. Sandha, Marty Cole, S.Y.D. Bass, Gary May, Jonathan Love, Vincent G. Bain, John McKaigney, Richard N. Fedorak. (2008) Allopurinol to Prevent Pancreatitis After Endoscopic Retrograde Cholangiopancreatography: A Randomized Placebo-Controlled Trial. Clinical Gastroenterology and Hepatology 6:4, 465-471
CrossRef30
Jun Kyu Lee, Ji Kon Ryu, Joo Kyoung Park, Sang Hyub Lee, Won Jae Yoon, Yong-Tae Kim, Hyun Chae Jung, Yong Bum Yoon. (2008) Effects of Nafamostat Mesilate on the Prevention of Cerulein-Induced Acute Pancreatitis. Pancreas 36:3, 255-260
CrossRef31
Chan-Sup Shim. 2008. Balloon Dilation of the Papilla. , 97-107.
CrossRef32
Atsushi Sofuni, Hiroyuki Maguchi, Takao Itoi, Akio Katanuma, Hiroyuki Hisai, Teitetsu Niido, Masayuki Toyota, Tsuneshi Fujii, Youji Harada, Tadanori Takada. (2007) Prophylaxis of Post–Endoscopic Retrograde Cholangiopancreatography Pancreatitis by an Endoscopic Pancreatic Spontaneous Dislodgement Stent. Clinical Gastroenterology and Hepatology 5:11, 1339-1346
CrossRef33
Hiroki Takahashi, Hitoshi Funahashi, Hirozumi Sawai, Yoichi Matsuo, Minoru Yamamoto, Yuji Okada, Hiromitsu Takeyama, Tadao Manabe. (2007) Synthetic Serine Protease Inhibitor, Gabexate Mesilate, Prevents Nuclear Factor-κB Activation and Increases TNF-α-Mediated Apoptosis in Human Pancreatic Cancer Cells. Digestive Diseases and Sciences 52:10, 2646-2652
CrossRef34
Kei Ito, Naotaka Fujita, Yutaka Noda, Go Kobayashi, Jun Horaguchi, Osamu Takasawa, Takashi Obana, Takuro Endo, Kazunari Nakahara. (2007) RISK MANAGEMENT OF ENDOSCOPIC SPHINCTEROTOMY FOR CHOLEDOCHOLITHIASIS. Digestive Endoscopy 19:s1, S44-S48
CrossRef35
Dan Rudin, Alexander Kiss, Robert V Wetz, Vincent M Sottile. (2007) Somatostatin and gabexate for post-endoscopic retrograde cholangiopancreatography pancreatitis prevention: Meta-analysis of randomized placebo-controlled trials. Journal of Gastroenterology and Hepatology 22:7, 977-983
CrossRef36
Gianpiero Manes, Sandro Ardizzone, Giovanni Lombardi, Generoso Uomo, Oreste Pieramico, Gabriele Bianchi Porro. (2007) Efficacy of postprocedure administration of gabexate mesylate in the prevention of post-ERCP pancreatitis: a randomized, controlled, multicenter study. Gastrointestinal Endoscopy 65:7, 982-987
CrossRef37
Changbin Shi, Xia Zhao, Xiangdong Wang, Liming Zhao, Roland Andersson. (2007) Potential effects of PKC or protease inhibitors on acute pancreatitis-induced tissue injury in rats. Vascular Pharmacology 46:6, 406-411
CrossRef38
Scott T. Cooper, Adam Slivka. (2007) Incidence, Risk Factors, and Prevention of Post-ERCP Pancreatitis. Gastroenterology Clinics of North America 36:2, 259-276
CrossRef39
Angelo Andriulli, Gioacchino Leandro, Telemaco Federici, Antonio Ippolito, Rosario Forlano, Angelo Iacobellis, Vito Annese. (2007) Prophylactic administration of somatostatin or gabexate does not prevent pancreatitis after ERCP: an updated meta-analysis. Gastrointestinal Endoscopy 65:4, 624-632
CrossRef40
Jun Kyu Lee, Joo Kyung Park, Won Jae Yoon, Sang Hyub Lee, Kwang Hyuck Lee, Ji Kon Ryu, Yong-Tae Kim, Yong Bum Yoon. (2007) Risk for Post-ERCP Pancreatitis After Needle Knife Precut Sphincterotomy Following Repeated Cannulation Attempts. Journal of Clinical Gastroenterology 41:4, 427-431
CrossRef41
Ghalib H. Abid, H. Priyantha Siriwardana, Adrian Holt, Basil J. Ammori. (2007) Mild ERCP-induced and non-ERCP-related acute pancreatitis: two distinct clinical entities?. Journal of Gastroenterology 42:2, 146-151
CrossRef42
Toshiharu Ueki, Keisuke Otani, Kenichiro Kawamoto, Aiko Shimizu, Naruhito Fujimura, Seigo Sakaguchi, Toshiyuki Matsui. (2007) Comparison between ulinastatin and gabexate mesylate for the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis: a prospective, randomized trial. Journal of Gastroenterology 42:2, 161-167
CrossRef43
Young Koog Cheon, Kwang Bum Cho, James L. Watkins, Lee McHenry, Evan L. Fogel, Stuart Sherman, Glen A. Lehman. (2007) Frequency and severity of post-ERCP pancreatitis correlated with extent of pancreatic ductal opacification. Gastrointestinal Endoscopy 65:3, 385-393
CrossRef44
Guang-Su Xiong, Shu-Ming Wu, Zhen-Hua Wang, Jian-Zhong Mo, Shu-Dong Xiao. (2007) Effects of thalidomide in experimental models of post-endoscopic retrograde cholangiopancreatography pancreatitis. Journal of Gastroenterology and Hepatology 22:3, 371-376
CrossRef45
Yasunori Sato, Seisuke Okamura, Masahiko Nakasono, Rika Aoki, Jiro Nakamoto, Naoki Muguruma, Susumu Ito. (2007) Evaluation of serum amylase and gabexate mesilate with endoscopic papillary balloon dilatation. The Journal of Medical Investigation 54:1,2, 65-71
CrossRef46
Jeremy S. Rochester, David L. Jaffe. (2007) Minimizing Complications in Endoscopic Retrograde Cholangiopancreatography and Sphincterotomy. Gastrointestinal Endoscopy Clinics of North America 17:1, 105-127
CrossRef47
Hidetaka Watanabe, Masashi Yoneda, Keiichi Tominaga, Tsuneo Monma, Kazunari Kanke, Tadahito Shimada, Akira Terano, Hideyuki Hiraishi. (2007) Comparison between endoscopic papillary balloon dilatation and endoscopic sphincterotomy for the treatment of common bile duct stones. Journal of Gastroenterology 42:1, 56-62
CrossRef48
Carl D Frank, Douglas G Adler. (2006) Post-ERCP pancreatitis and its prevention. Nature Clinical Practice Gastroenterology & Hepatology 3:12, 680-688
CrossRef49
(2006) Acute Pancreatitis. New England Journal of Medicine 355:9, 961-961
Full Text50
Hirofumi Fujishiro, Kyoichi Adachi, Tomonori Imaoka, Tomoyuki Hashimoto, Naruaki Kohge, Nobuyuki Moriyama, Hiroshi Suetsugu, Kousaku Kawashima, Yoshinori Komazawa, Norihisa Ishimura, Shunji Ishihara, Yuji Amano, Yoshikazu Kinoshita. (2006) Ulinastatin shows preventive effect on post-endoscopic retrograde cholangiopancreatography pancreatitis in a multicenter prospective randomized study. Journal of Gastroenterology and Hepatology 21:6, 1065-1069
CrossRef51
Leena Kandula, David C. Whitcomb, Mark E. Lowe. (2006) Genetic issues in pediatric pancreatitis. Current Gastroenterology Reports 8:3, 248-253
CrossRef52
Erik-Jan Wamsteker. (2006) Updates in biliary endoscopy. Current Opinion in Gastroenterology 22:3, 300-304
CrossRef53
Akira Matsukura, Taiichi Otani, Takeshi Takamoto, Hiroshi Usui, Yuka Goto, Masatoshi Makuuchi. (2006) Intracellular Activation of Trypsinogen in Rat Pancreatic Acini After Supramaximal Secretagogue Stimulation. Pancreas 32:2, 197-204
CrossRef54
F. Lella, F. Bagnolo, C. Rebuffat, M. Scalambra, U. Bonassi, E. Colombo. (2006) Use of the laparoscopic–endoscopic approach, the so-called “rendezvous” technique, in cholecystocholedocholithiasis. Surgical Endoscopy 20:3, 419-423
CrossRef55
Miho Sekimoto, Tadahiro Takada, Yoshifumi Kawarada, Koichi Hirata, Toshihiko Mayumi, Masahiro Yoshida, Masahiko Hirota, Yasutoshi Kimura, Kazunori Takeda, Shuji Isaji, Masaru Koizumi, Makoto Otsuki, Seiki Matsuno. (2006) JPN Guidelines for the management of acute pancreatitis: epidemiology, etiology, natural history, and outcome predictors in acute pancreatitis. Journal of Hepato-Biliary-Pancreatic Surgery 13:1, 10-24
CrossRef56
Michael Camilleri. (2005) GIH Clinical Research Update: 2004–2005. Clinical Gastroenterology and Hepatology 3:12, 1161-1166
CrossRef57
Peter Felderbauer, Christophe Muller, Kerem Bulut, Orlin Belyaev, Frank Schmitz, Waldemar Uhl, Wolfgang E. Schmidt. (2005) Pathophysiology and Treatment of Acute Pancreatitis: New Therapeutic Targets - A Ray of Hope?. Basic <html_ent glyph="@amp;" ascii="&"/> Clinical Pharmacology <html_ent glyph="@amp;" ascii="&"/> Toxicology 97:6, 342-350
CrossRef58
Roberto Caronna, Loretta Diana, Italo Nofroni, Simone Sibio, Stefania Catinelli, Paolo Sammartino, Piero Chirletti. (2005) Effects of Gabexate Mesilate (FOY) on Amylase and Phospholipase A2 in Human Serum and Pancreatic Juice. Digestive Diseases and Sciences 50:5, 868-873
CrossRef59
Yukio Mikami, Kazunori Takeda, Kazuhisa Matsuda, Huang Qiu-Feng, Shoji Fukuyama, Shinichi Egawa, Makoto Sunamura, Seiki Matsuno. (2005) Rat Experimental Model of Continuous Regional Arterial Infusion of Protease Inhibitor and Its Effects on Severe Acute Pancreatitis. Pancreas 30:3, 248-253
CrossRef60
Takeshi Tsujino, Yutaka Komatsu, Hiroyuki Isayama, Kenji Hirano, Naoki Sasahira, Natsuyo Yamamoto, Nobuo Toda, Yukiko Ito, Yousuke Nakai, Minoru Tada, Masayuki Matsumura, Haruhiko Yoshida, Takao Kawabe, Yasushi Shiratori, Masao Omata. (2005) Ulinastatin for pancreatitis after endoscopic retrograde cholangiopancreatography: A randomized, controlled trial. Clinical Gastroenterology and Hepatology 3:4, 376-383
CrossRef61
Jaimie D. Nathan, Joelle Romac, Ruth Y. Peng, Michael Peyton, Raymond J. MacDonald, Rodger A. Liddle. (2005) Transgenic expression of pancreatic secretory trypsin inhibitor-I ameliorates secretagogue-induced pancreatitis in mice. Gastroenterology 128:3, 717-727
CrossRef62
Tobias Keck, Veronika Friebe, Andrew L. Warshaw, Bozena A. Antoniu, Gerald Waneck, Stefan Benz, Ulrich T. Hopt, Carlos Fernández-del-Castillo. (2005) Pancreatic Proteases in Serum Induce Leukocyte-Endothelial Adhesion and Pancreatic Microcirculatory Failure. Pancreatology 5:2-3, 241-250
CrossRef63
Walter Halangk, Markus M. Lerch. (2004) Early events in acute pancreatitis. Gastroenterology Clinics of North America 33:4, 717-731
CrossRef64
Julia Mayerle, Peter Simon, Markus M. Lerch. (2004) Medical treatment of acute pancreatitis. Gastroenterology Clinics of North America 33:4, 855-869
CrossRef65
James A. DiSario, Martin L. Freeman, David J. Bjorkman, Padraic MacMathuna, Bret T. Petersen, Philip E. Jaffe, Thomas G. Morales, Lee J. Hixson, Stuart Sherman, Glen A. Lehman, M. Mazen Jamal, Firas H. Al-Kawas, Mukul Khandelwal, Joseph P. Moore, Gregory A. Derfus, Priya A. Jamidar, Francisco C. Ramirez, Michael E. Ryan, Karen L. Woods, David L. Carr-Locke, Stephen C. Alder. (2004) Endoscopic balloon dilation compared with sphincterotomy for extraction of bile duct stones. Gastroenterology 127:5, 1291-1299
CrossRef66
Todd H. Baron, Gavin C. Harewood. (2004) Endoscopic Balloon Dilation of the Biliary Sphincter Compared to Endoscopic Biliary Sphincterotomy for Removal of Common Bile Duct Stones During ERCP: A Metaanalysis of Randomized, Controlled Trials. The American Journal of Gastroenterology 99:8, 1455-1460
CrossRef67
A. Lavy, A. Karban, A. Suissa, K. Yassin, I. Hermesh, A. Ben-Amotz. (2004) Natural β-Carotene for the Prevention of Post-ERCP Pancreatitis. Pancreas 29:2, e45-e50
CrossRef68
Angelo Andriulli, Luigi Solmi, Silvano Loperfido, Pietro Leo, Virginia Festa, Angelo Belmonte, Fulvio Spirito, Michele Silla, Giovambattista Forte, Vittorio Terruzzi, Giorgio Marenco, Enrico Ciliberto, Antonio Sabatino, Fabio Monica, Maria Rita Magnolia, Francesco Perri. (2004) Prophylaxis of ERCP-related pancreatitis: A randomized, controlled trial of somatostatin and gabexate mesylate1 1The trial was designed and the manuscript was written by Dr. Andriulli. No pharmaceutical or private grants were searched for or made available for performing the present work.. Clinical Gastroenterology and Hepatology 2:8, 713-718
CrossRef69
DIMITRIOS ARVANITIDIS, GEORGE K ANAGNOSTOPOULOS, DIMITRIOS GIANNOPOULOS, ATHANASIOS PANTES, ROXANNE AGARITSI, GEORGE MARGANTINIS, STAVROS TSIAKOS, GEORGE SAKORAFAS, PANAGIOTIS KOSTOPOULOS. (2004) Can somatostatin prevent post-ERCP pancreatitis? Results of a randomized controlled trial. Journal of Gastroenterology and Hepatology 19:3, 278-282
CrossRef70
Thilo Hackert, Jens Werner, Martha-Maria Gebhard, Ernst Klar. (2004) Effects of heparin in experimental models of acute pancreatitis and post-ERCP pancreatitis. Surgery 135:2, 131-138
CrossRef71
Markus M. Lerch, Elke Albrecht, Manuel Ruthenbürger, Julia Mayerle, Walter Halangk, Burkhard Krüger. (2003) Pathophysiology of Alcohol-Induced Pancreatitis. Pancreas 27:4, 291-296
CrossRef72
Kunio Takeuchi, Yasushi Tsuzuki, Tetsu Ando, Masao Sekihara, Takashi Hara, Takayuki Kori, Hiroki Nakajima, Hiroyuki Kuwano. (2003) DISTAL PANCREATECTOMY: IS STAPLE CLOSURE BENEFICIAL?. ANZ Journal of Surgery 73:11, 922-925
CrossRef73
Seiichi Kato, Shoichiro Kamagata, Tohru Asakura, Kyoko Ozawa, Masaki Nio, Ryoji Ohi, Mitsutoshi Munakata, Kazuie Iinuma. (2003) A Newly Developed Small-Caliber Videoduodenoscope for Endoscopic Retrograde Cholangiopancreatography in Children. Journal of Clinical Gastroenterology 37:2, 173-176
CrossRef74
H Yamashita, T Otani, T Shioiri, T Takayama, C Kakiuchi, T Todani, M Makuuchi. (2003) Smallest Todani’s type II choledochal cyst. Digestive and Liver Disease 35:7, 498-502
CrossRef75
Zhi-Jun He, John H. Winston, Tony E. Yusuf, Maria-Adelaide Micci, Asem Elfert, Shu-Yuan Xiao, Pankaj J. Pasricha. (2003) Intraductal Administration of an NK1 Receptor Antagonist Attenuates the Inflammatory Response to Retrograde Infusion of Radiological Contrast in Rats: Implications for the Pathogenesis and Prevention of ERCP-Induced Pancreatitis. Pancreas 27:1, e13-e17
CrossRef76
F. Pelagotti, M. Cecchi, A. Messori, . (2003) Use of gabexate mesylate in Italian hospitals: a multicentre observational study. Journal of Clinical Pharmacy and Therapeutics 28:3, 191-196
CrossRef77
Bill Murray, Ross Carter, Clem Imrie, Susan Evans, Criostoir O’suilleabhain. (2003) Diclofenac reduces the incidence of acute pancreatitis after endoscopic retrograde cholangiopancreatography. Gastroenterology 124:7, 1786-1791
CrossRef78
RMS Mitchell, MF Byrne, J Baillie. (2003) Pancreatitis. The Lancet 361:9367, 1447-1455
CrossRef79
James H. Grendell. (2003) Genetic factors in pancreatitis. Current Gastroenterology Reports 5:2, 105-109
CrossRef80
Jong H Nam, Sreekant Murthy. (2003) Acute pancreatitis – the current status in management. Expert Opinion on Pharmacotherapy 4:2, 235-241
CrossRef81
Hemant Pande, Paul J Thuluvath. (2003) Pharmacological Prevention of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis. Drugs 63:17, 1799-1812
CrossRef82
M. Barthet. (2002) Pancréatite aiguë compliquant la cholanglo-pancréatographie rétrograde endoscopique (CPRE) et la ponction dirigée sous échoendoscopie. Acta Endoscopica 32:S2, 511-515
CrossRef83
J.G. Albert, J.F. Riemann. (2002) ERCP and MRCP – when and why. Best Practice & Research Clinical Gastroenterology 16:3, 399-419
CrossRef84
Ulf Petersson, Anders Borgström, Kjell Ohlsson, Frans-Thomas Fork, Ervin Toth. (2002) Enzyme Leakage, Trypsinogen Activation, and Inflammatory Response in Endoscopic Retrograde Cholangiopancreatography-Induced Pancreatitis. Pancreas 24:4, 321-328
CrossRef85
&NA;. (2002) Acute pancreatitis; target intensive therapy to those most likely to have a severe attack. Drugs & Therapy Perspectives 18:5, 9-12
CrossRef86
John Baillie. (2002) Predicting and preventing Post-ERCP pancreatitis. Current Gastroenterology Reports 4:2, 112-119
CrossRef87
J TOOULI, M BROOKE-SMITH, C BASSI, D CARR-LOCKE, J TELFORD, P FREENY, C IMRIE, R TANDON. (2002) Guidelines for the management of acute pancreatitis. Journal of Gastroenterology and Hepatology 17, S15-S39
CrossRef88
Janak N. Shah, Michael L. Kochman. (2001) Endoscopic management of biliary tract disease. Current Opinion in Gastroenterology 17:5, 468-473
CrossRef89
Peter R Thomas, Shomik Sengupta. (2001) Prediction of pancreatitis following endoscopic retrograde cholangiopancreatography by the 4-h post procedure amylase level. Journal of Gastroenterology and Hepatology 16:8, 923-926
CrossRef90
P. A. Testoni, F. Bagnolo, A. Andriulli, G. Bernasconi, S. Crotta, F. Lella, A. Lomazzi, G. Minoli, C. Natale, A. Prada, G. L. Toti, A. Zambelli. (2001) Octreotide 24-h prophylaxis in patients at high risk for post-ERCP pancreatitis: results of a multicenter, randomized, controlled trial. Alimentary Pharmacology and Therapeutics 15:7, 965-972
CrossRef91
Colm J. O'Loughlin, Umaprasanna S. Karnam, Jamie S. Barkin. (2001) Hope or hype-cytokine therapy in ERCP-induced pancreatitis. The American Journal of Gastroenterology 96:6, 1930-1932
CrossRef92
Akira Ohashi, Kiichi Tamada, Takeshi Tomiyama, Shinichi Wada, Toshihiko Higashizawa, Yasuhiko Gotoh, Yukihiro Satoh, Takamitsu Miyata, Shigeo Tano, Kenichi Ido, Kentaro Sugano. (2001) Epinephrine irrigation for the prevention of pancreatic damage after endoscopic balloon sphincteroplasty. Journal of Gastroenterology and Hepatology 16:5, 568-571
CrossRef93
Jacques Devière, Olivier Le Moine, Jean-Luc Van Laethem, Pierre Eisendrath, Axelle Ghilain, Nathalie Severs, Marielle Cohard. (2001) Interleukin 10 reduces the incidence of pancreatitis after therapeutic endoscopic retrograde cholangiopancreatography. Gastroenterology 120:2, 498-505
CrossRef94
Ian D. Norton, Jonathan E. Clain. (2001) Optimising Outcomes in Acute Pancreatitis. Drugs 61:11, 1581-1591
CrossRef95
Satoru Naruse, Youxue Wang, Motoji Kitagawa, Hiroshi Ishiguro, Yasunaga Seki, Tsuyoshi Ozaki, Tetsuo Hayakawa. (2000) Long-Term Effects of Nafamostat and Imipenem on Experimental Acute Pancreatitis in Rats. Pancreas 21:3, 290-295
CrossRef96
P.A. Testoni, F. Bagnolo, C. Natale, M. Primignani. (2000) Incidence of post-endoscopic retrograde-cholangiopancreatography/sphincterotomy pancreatitis depends upon definition criteria. Digestive and Liver Disease 32:5, 412-418
CrossRef97
J.F. Riemann. (2000) Incidence of post-endoscopic retrograde cholangiopancreatography/sphincterotomy pancreatitis depends upon definition criteria. Digestive and Liver Disease 32:5, 419-421
CrossRef98
Taiichi Otani, Akira Matsukura. (2000) pH Modulator Chloroquine Prevents Diet-Induced Acute Pancreatitis. Pancreas 20:4, 423-424
CrossRef99
Jean Perrault. (2000) HEREDITARY PANCREATITIS. Medical Clinics of North America 84:3, 519-529
CrossRef100
David C. Whitcomb. (2000) GENETIC PREDISPOSITIONS TO ACUTE AND CHRONIC PANCREATITIS. Medical Clinics of North America 84:3, 531-547
CrossRef101
Brugge, William R., Van Dam, Jacques, . (1999) Pancreatic and Biliary Endoscopy. New England Journal of Medicine 341:24, 1808-1816
Full Text102
Enns, Baillie. (1999) Review article: the treatment of acute biliary pancreatitis. Alimentary Pharmacology and Therapeutics 13:11, 1379-1389
CrossRef103
Sven Wollschläger, Klaus Pätzold, Thomas Bulang, Dieter Meißner, Heiner Porst. (1999) Einfluß einer prophylaktischen Selensubstitution auf die Entwicklung der ERCP-bedingten akuten Pankreatitis. Medizinische Klinik 94:S3, 81-83
CrossRef104
David C. Whitcomb. (1999) THE SPECTRUM OF COMPLICATIONS OF HEREDITARY PANCREATITIS. Gastroenterology Clinics of North America 28:3, 525-541
CrossRef105
Suresh Karne, Fred S. Gorelick. (1999) ETIOPATHOGENESIS OF ACUTE PANCREATITIS. Surgical Clinics of North America 79:4, 699-710
CrossRef106
J. P. Caucanas, Ph. E. Houcke. (1999) Complications de la sphinctérotomie endoscopique. Acta Endoscopica 29:S2, 386-396
CrossRef107
Stephen P. Martin, Charles D. Ulrich. (1999) Complicated acute pancreatitis. Current Treatment Options in Gastroenterology 2:3, 215-225
CrossRef108
Pier Alberto Testoni, Francesco Bagnolo, Salvatore Caporuscio, Fausto Lella. (1999) Serum amylase measured four hours after endoscopic sphincterotomy is a reliable predictor of postprocedure pancreatitis. The American Journal of Gastroenterology 94:5, 1235-1241
CrossRef109
Giovanni D. De Palma, Carlo Catanzano. (1999) Use of corticosteroids in the prevention of post-ERCP pancreatitis: results of a controlled prospective study. The American Journal of Gastroenterology 94:4, 982-985
CrossRef110
David C. Whitcomb. (1999) New insights into hereditary pancreatitis. Current Gastroenterology Reports 1:2, 154-160
CrossRef111
Klaus Mergener, John Baillie, . (1999) The Role of ERCP in Gallstone Pancreatitis. Journal of Intensive Care Medicine 14:2, 74-85
CrossRef112
Martin E. Maldonado, Patrick G. Brady, Jay J. Mamel, Bruce Robinson. (1999) Incidence of pancreatitis in patients undergoing sphincter of Oddi manometry (SOM). The American Journal of Gastroenterology 94:2, 387-390
CrossRef113
Walter J. Hogan. (1998) Stenting the pancreas: Is this the solution to post-ERCP pancreatitis?. Gastroenterology 115:6, 1591-1594
CrossRef114
SATOSHI IKEI, MICHIO OGAWA, YASUO YAMAGUCHI. (1998) Blood concentrations of polymorphonuclear leucocyte elastase and interleukin-6 are indicators for the occurrence of multiple organ failures at the early stage of acute pancreatitis. Journal of Gastroenterology and Hepatology 13:12, 1274-1283
CrossRef115
Jerome H. Siegel, Seth A. Cohen, Franklin E. Kasmin. (1998) Re: Uchida et al. Endoscopic Lithotomy of Common Bile Duct Stones With Sublingual Nitroglycerin and Guidewire. The American Journal of Gastroenterology 93:5, 845-846
CrossRef116
Paul Miskovitz. (1998) Acute pancreatitis. Critical Care Medicine 26:5, 816-817
CrossRef117
MINOTI V. APTE, PAUL S. HABER, IAN D. NORTON, JEREMY S. WILSON. (1998) Alcohol and the pancreas. Addiction Biology 3:2, 137-150
CrossRef118
Minoti Apte, Ian Norton, Paul Haber, Tanya Applegate, Mark Korsten, Geoffrey McCaughan, Romano Pirola, Jeremy Wilson. (1998) The effect of ethanol on pancreatic enzymes–a dietary artefact?. Biochimica et Biophysica Acta (BBA) - General Subjects 1379:3, 314-324
CrossRef119
John A. Dumot, Darwin L. Conwell, J. Barry O'Connor, D. Roy Ferguson, John J. Vargo, David S. Barnes, Steven S. Shay, Mark J. Sterling, Kenneth S. Horth, Khaled Issa, Jeffrey L. Ponsky, Gregory Zuccaro. (1998) Pretreatment With Methylprednisolone to Prevent Ercp-Induced Pancreatitis: A Randomized, Multicenter, Placebo-Controlled Clinical Trial. The American Journal of Gastroenterology 93:1, 61-65
CrossRef120
J. C. Paris, J. P. Caucanas. (1997) Pancréatite aiguë après CPRE. Acta Endoscopica 27:4, 339-344
CrossRef121
PAUL S HABER, ROMANO C PIROLA, JEREMY S WILSON. (1997) CLINICAL UPDATE: Management of acute pancreatitis. Journal of Gastroenterology and Hepatology 12:3, 189-197
CrossRef122
Huibregtse, Kees, . (1996) Complications of Endoscopic Sphincterotomy and Their Prevention. New England Journal of Medicine 335:13, 961-963
Full Text
