Endoscopy 2020; 52(S 01): S78
DOI: 10.1055/s-0040-1704236
ESGE Days 2020 oral presentations
Friday, April 24, 2020 08:30 – 10:30 ERCP complications Liffey Meeting Room 2
© Georg Thieme Verlag KG Stuttgart · New York

URINASTATIN VERSUS NAFAMOSTAT MESYLATE IN THE PREVENTION OF POST-ERCP PANCREATITIS

JW Lee
1   Division of Gastroenterology, Department of Internal Medicine, Pusan National University, Yangsan-si, Korea, Republic of
,
DH Kang
1   Division of Gastroenterology, Department of Internal Medicine, Pusan National University, Yangsan-si, Korea, Republic of
,
HW Kim
1   Division of Gastroenterology, Department of Internal Medicine, Pusan National University, Yangsan-si, Korea, Republic of
,
SB Park
1   Division of Gastroenterology, Department of Internal Medicine, Pusan National University, Yangsan-si, Korea, Republic of
,
SJ Kim
1   Division of Gastroenterology, Department of Internal Medicine, Pusan National University, Yangsan-si, Korea, Republic of
,
HS Nam
1   Division of Gastroenterology, Department of Internal Medicine, Pusan National University, Yangsan-si, Korea, Republic of
› Author Affiliations
Further Information

Publication History

Publication Date:
23 April 2020 (online)

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    Aims Pancreatitis is a major complication of ERCP. Nafamostat mesylate (Futhan) and Urinastatin (Ulistin) are commonly used to prevent and treat pancreatitis in Korea. However, there is no comparative study to evaluate efficacy of these two drugs. The aim of our study is a comparison of the efficacy of Mesilate and Urinastatin for PEP prevention.

    Methods From January 2016 to Aprile 2019, a total of 1797 patients who underwent ERCP were analyzed. Patients received continuous infusion of nafamostat mesylate (1175 patients) or with 150,000 unit of Urinastatin (622 patients). Serum amylase and lipase levels were checked before ERCP, 4 and 24 hours after ERCP, and when clinically indicated. Patients usually present within a few hours with severe epigastric pain, often radiating to the back, nausea and mild fever with raised pancreatic enzyme levels. Pancreatitis is diagnosed if two of the following three criteria is present; pain consistent with acute pancreatitis, raised serum amylase or lipase levels more than three times normal and (or) typical imaging findings. The incidence of PEP ranges from 3 to 10%. Patient-related risk factors include previous history of PEP, suspected sphincter of Oddi dysfunction, female sex, younger patient age, normal serum bilirubin levels, history of acute recurrent pancreatitis, pregnancy, and cannabis use. Procedure related factors, such as difficult cannulation (multiple attempts or duration > 5-10 min) and large-balloon dilatation of the papilla of an intact biliary sphincter (especially for short duration (<  1 min) significantly increase the risk of PEP.

    Results There was a significant difference in the incidence of PEP between the Nafamostat mesylate and Urinastatin groups (4.0851% vs 2.0900%, respectively; OR: 0.501295, 95% CI: 0.2694 to 0.9323, Z statistic: 2.181, P value: 0.0292).

    Conclusions Urinastatin prophylaxis is more effective in prevention of post-ERCP pancreatitis compared to Nafamostat mesylate.


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