A randomized controlled trial of pentoxifylline for the prevention of post-ERCP pancreatitis

• Published in: Gastrointestinal endoscopy Vol. 66; no. 3; pp. 513 - 518
• Main Authors: Kapetanos, Dimitrios, MD, Kokozidis, Georgios, MD, Christodoulou, Dimitrios, MD, Mistakidis, Konstantinos, MD, Sigounas, Dimitrios, MD, Dimakopoulos, Konstantinos, MD, Kitis, Georgios, MD, Tsianos, Epaminondas V., PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.09.2007; Elsevier
• Subjects: Aged; Bile Duct Diseases - diagnosis; Bile Duct Diseases - therapy; Biological and medical sciences; Cholangiopancreatography, Endoscopic Retrograde - adverse effects; Digestive system; Digestive system. Abdomen; Endoscopy; Female; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Hyperamylasemia - prevention & control; Investigative techniques, diagnostic techniques (general aspects); Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; Other diseases. Semiology; Pancreatitis - prevention & control; Pentoxifylline - therapeutic use; Premedication; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Sphincterotomy, Endoscopic - adverse effects; IL; tumor necrosis factor; interleukin; TNF; Biliary tract; Vasodilator agent; Hemorrhage; Prevention; Gastroenterology; Diverticulum; Xanthine derivatives; Diagnosis; Endoscopy; Pancreatic disease; Human; Cholangiopancreatography; Radiodiagnosis; Hyperamylasemia; Pancreatitis; Oral administration; Enzyme inhibitor; Hepatobiliary disease; Pancreatic duct; Pentoxifylline; Treatment; Tumor necrosis factor; Animal; Digestive diseases; Biliary colic
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2007.03.1045

Background Pentoxifylline can ameliorate pancreatitis in animal models because of its anti–tumor necrosis factor properties. Objective Our purpose was to study the safety and efficacy of pentoxifylline in the prevention of post-ERCP pancreatitis. Design Patients due to undergo ERCP for various indications were randomized to receive pentoxifylline 400 mg orally 3 times, beginning the day before ERCP (2 and 10 pm ) until the night after the procedure (6 am and 2 and 10 pm ) or to receive no preventive medication. Serum amylase values were determined before and 6 and 24 hours after ERCP. Diagnosis and grading of the severity of complications was performed according to consensus criteria. Patients One hundred fifty-eight patients received pentoxifylline (group A) and 162 had no medication (group B). The groups were similar in distributions of sex, biliary sphincterotomy, pancreatography, pancreatic duct cannulations, stone extraction, stent placement, and presence of periampullary diverticulum. Group A patients were younger (mean age 63 vs 68 years, P < .05) and biliary colic was a more frequent indication (30 vs 12, P < .05). Results Nine (5.6%) patients in group A and 5 (3%) in group B had pancreatitis (2 and 1 severe, respectively; P  = .28). Serum amylase values were similar in baseline and 6- and 24-hour samples. Two (1.2%) patients in group A and 7 (4.3%) in group B had hemorrhage. Limitations This was not a double-blind trial. Conclusions In this study pentoxifylline did not protect against post-ERCP pancreatitis or hyperamylasemia.