Post-ERCP pancreatitis: is allopurinol the Holy Grail?

摘要

Despite years of searching, American endoscopists have been unable to find a pharmacologic means of preventing post-ERCP pancreatitis. Many times, the tantalizing goal has appeared within grasp, only to prove a mirage. Large trials based on promising preliminary evidence have failed to show a benefit from either familiar agents (steroids, octreotide, nonionic contrast) or biotech products (interleukin10, platelet-activating factor antagonists). Europeans have had better luck, finding (in meta-analysis) some benefit with somatostatin or protracted infusions of gabexate, but these agents have not proven sufficiently effective and convenient to prompt large-scale American studies. In this context, allopurinol has emerged as a potentially effective prophylactic agent. It is an inexpensive, safe, orally administered drug for which there is scientific rationale and proven efficacy in a dog model of post-ERCP pancreatitis. One of two large European studies showed a benefit in patients who were undergoing ERCP. Unfortunately, the study of Mosler et al published in this issue of Gastrointestinal Endoscopy suggests that allopurinol is not the answer.