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Efficacy of chymotrypsin in the prevention of postendoscopic retrograde cholangiopancreatography pancreatitis
The Egyptian Journal of Internal Medicine volume 31, pages 292–295 (2019)
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Abstract
Background
Pancreatitis is common after endoscopic retrograde cholangiopancreatography (ERCP).
Aim
To assess the pharmacological effect of diclofenac, allopurinol and chymotrypsin in the prevention of postendoscopic retrograde cholangiopancreatography pancreatitis (PEP).
Settings and design
Calcular obstructive jaundice patients without pancreatitis scheduled for ERCP were randomized into three groups.
Materials and methods
The 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 analysis
Analysis of variance for continuous variables and χ2 for categorical variables.
Results
One 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.
Conclusion
Chymotrypsin 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.
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Attia, A.A., Elshimi, E.A., Fouad, T.R. et al. Efficacy of chymotrypsin in the prevention of postendoscopic retrograde cholangiopancreatography pancreatitis. Egypt J Intern Med 31, 292–295 (2019). https://doi.org/10.4103/ejim.ejim_13_19
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DOI: https://doi.org/10.4103/ejim.ejim_13_19