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Post-ERCP Pancreatitis: Randomized, Prospective Study Comparing A Low- And High-osmolality Contrast Agent.

S. Sherman, R. Hawes, S. Rathgaber, M. Uzer, M. Smith, Q. Khusro, W. Silverman, D. Earle, G. Lehman
Published 1994 · Medicine

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Diagnostic and therapeutic ERCPs are complicated by pancreatitis in 1% to 10% of patients, and evidence suggests that the contrast agent used for ERCP may be important in the pathogenesis of such pancreatitis. This prospective, double-blind study was undertaken to determine whether the use of a low-osmolality, nonionic contrast agent (Omnipaque 300; iohexol, 672 mOsm/kg H2O) would reduce the frequency and severity of postprocedure pancreatitis as compared to a high-osmolality, ionic contrast agent (Hypaque 50%; diatrizoate sodium, 1515 mOsm/kg H20). Six hundred ninety patients undergoing diagnostic ERCP (pancreatogram, cholangiogram, or both) either with or without sphincter of Oddi manometry and therapy were randomized to iohexol or diatrizoate sodium. Postprocedure pancreatitis was diagnosed when the serum amylase or lipase level was elevated to at least four times the upper limits of normal at 18 hours and was associated with increased abdominal pain persisting for at least 24 hours after the procedure that required administration of narcotic analgesics. The pancreatitis was graded as mild, moderate, or severe depending on the length of hospital stay and the need for intervention. The overall frequency (7.2% versus 7.5%) and severity (4.3% mild, 2% moderate, 0.9% severe for the diatrizoate sodium group versus 4.3% mild, 2.6% moderate, and 0.6% severe for the iohexol group) of postprocedure pancreatitis and the frequency and severity within each procedure category were similar for the two contrast agent groups (p > .05).(ABSTRACT TRUNCATED AT 250 WORDS)
This paper references
Different contrast agents and development of pancreatitis after endoscopic retrograde pancreatography.
T. Short (1992)
10.3109/00365528509089637
A randomized trial of iohexol versus amidotrizoate in endoscopic retrograde pancreatography.
A. Jensen (1985)
10.1016/S0009-9260(82)80265-1
Metrizamide as contrast medium in endoscopic retrograde cholangio-pancreatography.
I. Hamilton (1982)
10.1055/S-2007-1013022
Iopamidol as contrast medium in endoscopic retrograde pancreatography: a prospective randomised comparison with diatrizoate.
H. J. O'Connor (1988)
10.1148/RADIOLOGY.183.1.1549654
Nonionic low-osmolality versus ionic high-osmolality contrast material for intravenous use in patients perceived to be at high risk: randomized trial.
B. Barrett (1992)
10.1136/gut.31.7.821
Pancreatitis after sphincter of Oddi manometry.
P. Rolny (1990)
10.1016/S1052-5157(18)30596-8
Complications of Sphincter of Oddi Manometry and Their Prevention
R. Hawes (1993)
10.1016/S0016-5107(90)71115-7
Sphincter of Oddi manometry: decreased risk of clinical pancreatitis with use of a modified aspirating catheter.
S. Sherman (1990)
10.1055/S-2007-1013024
Contrast media for ERCP.
A. Rambow (1988)
10.3109/00365527709181725
A comparison of a new non-ionic (metrizamide) and a dissociable (metrizoate) contrast medium in endoscopic retrograde pancreatography (ERP).
M. Osnes (1977)
10.1016/S0016-5107(85)72018-4
Hyperamylasemia after ERCP with ionic and non-ionic contrast media.
B. Hannigan (1985)
Trial of low versus high osmolar contrast media in endoscopic retrograde cholangiopancreatography.
A. Banerjee (1990)
10.3109/00365528809093847
Experimental pancreatography: a comparison of three contrast media.
A. Saari (1988)
10.1016/S0016-5107(91)70740-2
Endoscopic sphincterotomy complications and their management: an attempt at consensus.
P. Cotton (1991)
Different contrast agents and development of pancreatitis after endoscopic retrograde pancreatography.
P. Cotton (1992)
10.3109/00365528309181642
Morphology of the pancreatic ductal epithelium after traumatization of the papilla of Vater or endoscopic retrograde pancreatography with various contrast media in cats.
H. Bub (1983)
10.1016/0016-5085(91)90735-4
Complications of endoscopic sphincterotomy. A prospective series with emphasis on the increased risk associated with sphincter of Oddi dysfunction and nondilated bile ducts.
S. Sherman (1991)
10.1097/00006676-199105000-00013
ERCP‐ and Endoscopic Sphincterotomy‐Induced Pancreatitis
S. Sherman (1991)
A comparative study of contrast agents for endoscopic retrograde pancreatography.
J. Barkin (1991)
10.1016/S0025-6196(12)61226-9
Low-osmolality contrast media: a current perspective.
B. King (1989)
Different contrast agents and development of pancreatitis after endoscopic retrograde pancreatography.
A. Banerjee (1992)
The immediate effects of retrograde pancreatography on the pancreas.
L. Kivisaari (1984)
10.1055/S-2007-1013018
A randomised, prospective study comparing two contrast media in ERCP.
W. Cunliffe (1987)



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10.1136/gut.2008.148551
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M. Noble (2008)
Peut-on prévoir et prévenir la pancréatite aiguë post-cholangio-pancréatographie rétrograde endoscopique ?
P. Hastier (2001)
10.1016/j.dld.2011.05.010
Precut sphincterotomy, repeated cannulation and post-ERCP pancreatitis in patients with bile duct stone disease.
Pier Alberto Testoni (2011)
Acute necrotizing pancreatitis following coronary artery angiography: A case report
M. Hajimaghsoudi (2017)
Comparison of ionic, monomer, high osmolar contrast media with non-ionic, dimer, iso-osmolar contrast media in ERCP.
M. Ogawa (2013)
10.1016/S0016-5107(04)00363-3
A simple way of avoiding post-ERCP pancreatitis.
F. Lella (2004)
10.1056/NEJM199609263351302
Gabexate for the prevention of pancreatic damage related to endoscopic retrograde cholangiopancreatography. Gabexate in digestive endoscopy--Italian Group.
G. Cavallini (1996)
10.1046/j.1365-2036.2001.01015.x
Octreotide 24‐h prophylaxis in patients at high risk for post‐ERCP pancreatitis: results of a multicenter, randomized, controlled trial
P. Testoni (2001)
10.1007/s00534-009-0220-5
Post-ERCP pancreatitis
S. Arata (2010)
10.1097/SMJ.0b013e318290c6be
Risk Stratification for the Development of Post-ERCP Pancreatitis by Sphincter of Oddi Dysfunction Classification
S. Beltz (2013)
Comparison of the effect of non-ionic and ionic contrast agents on pancreatic histology in a canine model.
P. Pfau (2006)
10.1016/S0016-5085(98)70031-9
Pancreatic stenting prevents pancreatitis after biliary sphincterotomy in patients with sphincter of Oddi dysfunction.
P. Tarnasky (1998)
Mechanisms involved in the onset of post-ERCP pancreatitis.
R. Pezzilli (2002)
10.6092/1590-8577/2258
The role of nonsteroidal anti-inflammatory drugs in the prevention of post endoscopic retrograde cholangiopancreatography pancreatitis.
I. Sheikh (2014)
10.1111/j.1572-0241.2006.00959.x
Effect of Octreotide Administration in the Prophylaxis of Post-ERCP Pancreatitis and Hyperamylasemia: A Multicenter, Placebo-Controlled, Randomized Clinical Trial
Z. Li (2007)
10.1038/ajg.2010.136
Risk Factors for Post-ERCP Pancreatitis in High- and Low-Volume Centers and Among Expert and Non-Expert Operators: A Prospective Multicenter Study
P. Testoni (2010)
10.1159/000496349
Can Iodixanol Prevent Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis? A Prospective, Randomized, Controlled Trial
T. Ogura (2019)
10.1016/J.GIEC.2006.11.002
Minimizing complications in endoscopic retrograde cholangiopancreatography and sphincterotomy.
Jeremy S Rochester (2007)
10.1159/000136564
Ätiopathogenese und Prävention der iatrogenen Pankreatitis
Jörg Ringel (2008)
10.1136/gut.38.6.799
Endoscopic retrograde cholangiopancreatography and acute pancreatitis.
A. D. de Beaux (1996)
10.1016/S0016-5107(98)70318-9
Effects of bolus somatostatin in preventing pancreatitis after endoscopic pancreatography: results of a randomized study.
J. Bordas (1998)
10.4253/wjge.v2.i5.165
Endoscopic retrograde cholangiopancreatography associated pancreatitis: A 15-year review.
Kevin E. Woods (2010)
Pharmacological prevention of post-ERCP pancreatitis: which therapy is best?
A. Mariani (2003)
10.3748/WJG.15.4788
Effects of contrast media on the hepato-pancreato-biliary system.
O. Topçu (2009)
10.1016/S1542-3565(04)00062-X
Improved stent characteristics for prophylaxis of post-ERCP pancreatitis.
A. Rashdan (2004)
Complications à court terme de la cholangio-pancréatographie rétrograde endoscopique (CPRE) diagnostique et thérapeutique
M. Barthet (2002)
10.13105/WJMA.V7.I6.259
Prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis using pancreatic stents: A review of efficacy, diameter and length
Mitsuru Sugimoto (2019)
10.1007/BF03019323
Complications de la sphinctérotomie endoscopique
J. P. Caucanas (2008)
10.1016/S0016-5107(99)70385-8
Same-day discharge after endoscopic biliary sphincterotomy: observations from a prospective multicenter complication study. The Multicenter Endoscopic Sphincterotomy (MESH) Study Group.
M. Freeman (1999)
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Laparoendoscopic rendez-vous: a safe alternative to the treatment of choledocholithiasis.
Fernanda Kreve (2017)
10.4030/JJCS1979.31.6_979
A Case Report of Pancreas Abscess in a Post-ERCP Pancreatitis Patient who Underwent Cholangiocarcinoma Surgery
M. Kimura (2006)
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