Nifedipine for prevention of post-ERCP pancreatitis: A prospective, double-blind randomized study

• Published in: Gastrointestinal endoscopy 2002-08, Vol.56 (2), p.202-208
• Main Authors: Prat, Frédéric, Amaris, Juan, Ducot, Béatrice, Bocquentin, Muriel, Fritsch, Jacques, Choury, André Daniel, Pelletier, Gilles, Buffet, Catherine
• Format: Article
• Language: English
• Subjects: Acute Disease; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Calcium Channel Blockers - therapeutic use; Cholangiopancreatography, Endoscopic Retrograde - adverse effects; Digestive system; Female; Humans; Male; Medical sciences; Middle Aged; Nifedipine - therapeutic use; Pain, Postoperative - prevention & control; Pancreatitis - etiology; Pancreatitis - prevention & control; Pharmacology. Drug treatments; Prospective Studies; Risk Factors; Sphincterotomy, Endoscopic
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/S0016-5107(02)70178-8

Background: Pancreatitis is the most common complication of ERCP. Calcium channel inhibitors have been shown to prevent the development of experimental pancreatitis. The aim of this randomized, placebo-controlled trial was to determine whether the calcium channel blocker nifedipine prevents post-ERCP pancreatitis. Methods: Patients referred for ERCP were enrolled. Those being treated with a calcium channel inhibitor and those with acute or chronic pancreatitis were excluded. Nifedipine or placebo was administered orally less than 3 hours before and within 6 hours after ERCP. The main outcome measure was the number of cases of post-ERCP pancreatitis; a secondary outcome was the rate of post-ERCP pain (without pancreatitis) that persisted for 12 or more hours. Results: One hundred fifty-five patients (70 women, 85 men; mean [SD] age 65.8 [18.2] years; range, 23-97 years) were enrolled and randomized to receive nifedipine (76 patients) or placebo (79 patients). The two groups were comparable. Procedures performed were retrograde diagnostic cholangiopancreatography alone (n = 33), biliary sphincterotomy (n = 31), stone extraction (n = 39), stent placement (n = 37), sphincteroplasty (n = 5), and other (n = 3). ERCP was unsuccessful in 5 patients. A single case of severe pancreatitis was observed (placebo group). The rate of post-ERCP pancreatitis was not different between groups (nifedipine, 10 patients, 13.2%; placebo, 14 patients, 17.7%; p = 0.4). The frequency of post-ERCP pain was not different between the groups. The only independent predictor of post-ERCP pancreatitis was difficult cannulation in both groups (OR = 3.78: 95% CI [1.25, 11.45]). Conclusion: This study failed to demonstrate a significant effect of nifedipine in the prevention of post-ERCP pancreatitis. A multicenter trial with greater statistical power would be needed to demonstrate a benefit for this drug. (Gastrointest Endosc 2002;56:202-8.)