The Egyptian Journal of Internal Medicine (Jan 2019)

Efficacy of chymotrypsin in the prevention of postendoscopic retrograde cholangiopancreatography pancreatitis

  • Ahmed A Attia,
  • Esam A Elshimi,
  • Tamer R Fouad,
  • El-Sayed A Ibrahim,
  • Wael M Abdel-Razek

DOI
https://doi.org/10.4103/ejim.ejim_13_19
Journal volume & issue
Vol. 31, no. 3
pp. 292 – 295

Abstract

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Background Pancreatitis is common after endoscopic retrograde cholangiopancreatography (ERCP). Aim To assess the pharmacological effect of diclofenac, allopurinol and chymotrypsin in the prevention of postendoscopic retrograde cholangiopancreatography pancreatitis (PEP). Settings and design Calcular obstructive jaundice patients without pancreatitis scheduled for ERCP were randomized into three groups. Materials and methods The diclofenac group received 200 mg rectal suppositories immediately after ERCP, allopurinol received oral 300 mg 3 h before ERCP, and chymotrypsin received intramuscular injection immediately after ERCP. Serum amylase and lipase were measured before, 1, 6, and 24 h after ERCP and procedure-related risk factors for post-ERCP pancreatitis were recorded. Pancreatitis was considered when serum amylase or lipase levels elevated more than three times the upper limit of normal with newly developed abdominal pain lasting at least 24 h after ERCP. Statistical analysis Analysis of variance for continuous variables and χ2 for categorical variables. Results One hundred and fifty patients were included; diclofenac group (58 patients, 29 men, mean age 46.9±13.2 years), allopurinol (38 patients, 20 men, mean age 43.1±14.7 years) and chymotrypsin (54 patients, 28 men, mean age 40.6±17.3 years). Twelve (8%) patients developed PEP: the diclofenac group (n=4; 6.9%), allopurinol (n=6; 15.8%) while chymotrypsin (n=2; 3.7%), but this was not statistically significant (P=0.318). In patients who received chymotrypsin, regression of serum amylase and lipase to normal levels was much better compared with the other groups and was associated with better clinical improvement. Conclusion Chymotrypsin and allopurinol are comparable to diclofenac in the prevention of pancreatitis post-ERCP. Beside its prophylactic role, chymotrypsin could be effective in rapid improvement if PEP occurs.

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