Proton-Pump Inhibitor for the Prevention of Pancreatic Damage Related to Endoscopic Retrograde Cholangiopancreatography

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is associated with elevated levels of pancreatic enzymes and pancreatitis. The aim of this study was to assess the efficacy of rabeprazole sodium (RPZ), a proton-pump inhibitor (PPI), in inhibiting pancreatic secretion and thus preventing post-ERCP pancreatitis and hyperamylasemia. Methods: A total of 39 adult patients (mean age, 56.3 years), who had intraductal papillary mucinous tumor of the pancreas and were scheduled to undergo pancreatic juice cytology under ERCP, were enrolled and divided into two groups; 19 patients who had peptic ulcer or gastro-esophageal reflux disease given 10 mg/day of RPZ (PPI group), and 20 given neither PPI nor H2-blocker (non-PPI group). PPI was given orally, starting 7 or more days before ERCP and continuing for 14 or more days afterward. Acute pancreatitis was considered to be present if the serum amylase level was 5-fold greater than the upper limit of normal in association with the onset of pancreatic pain. Results: After the procedure 19 non-PPI patients (95%) and 14 PPI patients (70%) had elevated serum amylase levels. The mean serum amylase value after ERCP was 631 ± 726 IU/L in the non-PPI group, that was significantly higher than 257 ± 238 IU/L in the PPI group throughout 24 hours of observation (p = 0.002). One patient in the non-PPI group and none in the PPI group developed acute pancreatitis. There were no significant differences between the two groups in the duration of abnormally elevated serum amylase levels. Conclusion: Prophylactic treatment with a PPI seems to reduce pancreatic damage related to ERCP, as reflected by a reduction in the extent of increase in the serum amylase level.