Source: DGNews  |  Posted 8 years ago

By Ed Susman

ORLANDO, FL -- May 23, 2003 -- The administration of secretin at the time of endoscopic retrograde cholangiopancreatography (ERCP) appears to significantly reduce the risk of pancreatitis occurring after the procedure.

Researchers presented their findings here May 21st in an oral late-breaking presentation at Digestive Disease Week 2003. They said that compared to patients who received placebo, there were significant decreases in pancreatitis among patients receiving secretin who underwent biliary sphincterotomy or common bile duct cannulation.

"Secretin may have a role in reducing the risk of pancreatitis in certain groups of patients, such as those in whom a sphincterotomy is anticipated," said Dr. Paul Jowell, MD, associate professor of gastroenterology at Duke University Medical Center, Durham, North Carolina, United States. "Pancreatitis is the most feared complication of ERCP. Mortality from pancreatitis is infrequent but still a real concern."

He described results from a prospective, randomised, double-blind, placebo-controlled study comparing synthetic porcine secretin, a polypeptide hormone that increases the volume and bicarbonate content of pancreatic secretions, with placebo.

Dr. Jowell and colleagues randomised 979 patients to either of the treatments -- 488 received secretin 16 mcg and 491 received placebo.

Among 159 patients receiving placebo during biliary sphincterotomy, 21% developed some form of pancreatitis. Of the 140 patients who received secretin at the time of the procedure, 5% developed pancreatitis. The difference, Dr. Jowell said, was highly significant to the P<0.0001 level.

Of 368 patients receiving placebo during common bile duct cannulation, 15% developed pancreatitis. Of 361 who were given secretin, 7% developed some degree of pancreatitis, he said. That reached statistical significance at the P=0.001 level.

Dr. Jowell noted that most of the patients in both groups experienced either mild or moderate pain, requiring either no hospitalisation or less than 3 days in hospital. Because secretin costs about $300 per dose, and because of the cost and the relatively low level of major pancreatitis episodes, he said further work was necessary to define the patient population that would benefit from the treatment.

The work was supported by ChiRhoClin, Inc., Burtonsville, Maryland.

[Study title: Synthetic Secretin Administered at the Start of the Procedure Significantly Reduces the Risk of Post-ERCP Pancreatitis: A Randomized, Double-Blind, Placebo Controlled Trial. Abstract 500001]