Efficacy of chymotrypsin in the prevention of postendoscopic retrograde cholangiopancreatography pancreatitis

Abstract

EnBackgroundPancreatitis is common after endoscopic retrograde cholangiopancreatography (ERCP).AimTo assess the pharmacological effect of diclofenac, allopurinol and chymotrypsin in the prevention of postendoscopic retrograde cholangiopancreatography pancreatitis (PEP).Settings and designCalcular obstructive jaundice patients without pancreatitis scheduled for ERCP were randomized into three groups.Materials and methodsThe diclofenac group received 200 mg rectal suppositories immediately after ERCP, allopurinol received oral 300 mg 3 h before ERCP, and chymotrypsin received intramuscular injection immediately after ERCP. Serum amylase and lipase were measured before, 1, 6, and 24 h after ERCP and procedure-related risk factors for post-ERCP pancreatitis were recorded. Pancreatitis was considered when serum amylase or lipase levels elevated more than three times the upper limit of normal with newly developed abdominal pain lasting at least 24 h after ERCP.Statistical analysisAnalysis of variance for continuous variables and χ2 for categorical variables.ResultsOne hundred and fifty patients were included; diclofenac group (58 patients, 29 men, mean age 46.9±13.2 years), allopurinol (38 patients, 20 men, mean age 43.1±14.7 years) and chymotrypsin (54 patients, 28 men, mean age 40.6±17.3 years). Twelve (8%) patients developed PEP: the diclofenac group (n=4; 6.9%), allopurinol (n=6; 15.8%) while chymotrypsin (n=2; 3.7%), but this was not statistically significant (P=0.318). In patients who received chymotrypsin, regression of serum amylase and lipase to normal levels was much better compared with the other groups and was associated with better clinical improvement.ConclusionChymotrypsin and allopurinol are comparable to diclofenac in the prevention of pancreatitis post-ERCP. Beside its prophylactic role, chymotrypsin could be effective in rapid improvement if PEP occurs.