3346 Evaluation of recombinant human plateletactivating factor acetylhydrolase (rpaf-ah) for reducing the incidence and severity of post-ercp acute pancreatitis (ap).

Abstract

ERCP provides the opportunity to administer prophylactic therapy to reduce the incidence and severity of post-ERCP AP. Platelet activating factor (PAF) is a pro-inflammatory mediator that has been implicated in the pathogenesis of AP. PAF-AH is a naturally occurring human enzyme that degrades PAF to an inactive metabolite. Aim: To determine if the prophylactic administration of rPAF-AH decreases the incidence and severity of post-ERCP AP. Methods: Eligible patients had ≥ 1 of the following risk factors for post-ERCP AP: age ≤ 40 years; failed prior ERCP; history of unexplained, recurrent pancreatitis; scheduled to undergo pancreatic therapeutic ERCP, sphincter of Oddi manometry, or ERCP for presumed sphincter of Oddi dysfunction (SOD). Patients were randomized to receive an IV infusion of placebo or rPAF-AH (1 or 5 mg/kg) ≤ 1 hour prior to ERCP. Standard criteria were used to determine the presence and severity of post-ERCP AP (GI Endosc 1991;37:383). Results: A total of 600 patients (79% female) were enrolled. Results are summarized below: Conclusion: In this high-risk patient population, prophylactic administration of rPAF-AH resulted in a reduction in the incidence and possibly the severity of post-ERCP AP, but not to a statistically significant degree.