Effects of Gabexate Mesilate for the Prevention of Pancreatic Damage Related to ERCP

Jeen, Yoon Tae; Chun, Hoon Jai; Lee, Jung Whan; Hur, Byung Won; Lee, Hong Sik; Song, Chi Wook; Um, Soon Ho; Lee, Sang Woo; Choi, Jae Hyun; Kim, Chang Duk; Ryu, Ho Sang; Hyun, Jin Hai; Kang, Chang Don

Abstract

BACKGROUND/AIMS
Recent studies reported that 1g of gabexate mesilate (GM) was effective in preventing endoscopic retrograde cholangiopancreatography (ERCP)-related pancreatic damage. The aim of this study was to evaluate the effectiveness of low dose GM for the prevention of ERCP-related pancreatic damage.
METHODS
This study was performed prospectively with 102 consecutive patients (68 for the GM group, 34 for the placebo group) who were scheduled for ERCP. Infusion of GM (500 mg) was started 30 minutes before ERCP and continued for 12 hours afterward. The serum amylase and lipase were measured before ERCP and 4, 8, and 24 houps after ERCP.
RESULTS
The incidence of hyperenzymemia was 45.6% in the GM group and 55.9% in the control group (p=0.40). Acute pancreatitis was developed in only one patient who was given the placebo. Although difficult cannulation, visualization of the pancreatic duct, performance of therapeutic procedures, and longer total procedure time were associated with an increased incidence of hyperenzymemia, the incidence of pancreatic damage was not affected by the GM treatment in these conditions.
CONCLUSIONS
Prophylactic treatment with 500 mg of GM has no advantage for the prevention of ERCP-related pancreatic damage. Considering the cost effectiveness, further studies are necessary to identify the patients at greatest risk fot acute pancreatitis.