BACKGROUND/AIMS: In patients undergoing endoscopic retrograde cholangiopancreatography (ERCP), calcineurin activates zymogen, which results in pancreatitis. In this study, we aimed to determine the efficacy of tacrolimus, a calcineurin inhibitor, in preventing post-ERCP pancreatitis (PEP). METHODS: This was a prospective pilot study in which patients who underwent ERCP received tacrolimus (4 mg in two divided doses); this was the Tac group. A contemporaneous cohort of patients was included as a control group. All patients were followed-up for PEP. PEP was characterized by worsening abdominal pain with an acute onset, elevated pancreatic enzymes, and a duration of hospital stay of more than 48 hours. Serum tacrolimus levels were measured immediately before the procedure in the Tac group. RESULTS: There were no differences in the baseline characteristics between the Tac group (n=48) and the control group (n=51). Only four out of 48 patients (8.3%) had PEP in the Tac group compared to eight out of 51 patients (15.7%) who had PEP in the control group. The mean trough tacrolimus level in patients who developed PEP was significantly lower (p<0.05). CONCLUSION: Oral tacrolimus at a cumulative dose of 4 mg safely prevents PEP. Further randomized controlled studies are warranted to establish the role of tacrolimus in this context.
BACKGROUND/AIMS: In patients undergoing endoscopic retrograde cholangiopancreatography (ERCP), calcineurin activates zymogen, which results in pancreatitis. In this study, we aimed to determine the efficacy of tacrolimus, a calcineurin inhibitor, in preventing post-ERCP pancreatitis (PEP). METHODS: This was a prospective pilot study in which patients who underwent ERCP received tacrolimus (4 mg in two divided doses); this was the Tac group. A contemporaneous cohort of patients was included as a control group. All patients were followed-up for PEP. PEP was characterized by worsening abdominal pain with an acute onset, elevated pancreatic enzymes, and a duration of hospital stay of more than 48 hours. Serum tacrolimus levels were measured immediately before the procedure in the Tac group. RESULTS: There were no differences in the baseline characteristics between the Tac group (n=48) and the control group (n=51). Only four out of 48 patients (8.3%) had PEP in the Tac group compared to eight out of 51 patients (15.7%) who had PEP in the control group. The mean trough tacrolimus level in patients who developed PEP was significantly lower (p<0.05). CONCLUSION: Oral tacrolimus at a cumulative dose of 4 mg safely prevents PEP. Further randomized controlled studies are warranted to establish the role of tacrolimus in this context.
Authors: E Masci; G Toti; A Mariani; S Curioni; A Lomazzi; M Dinelli; G Minoli; C Crosta; U Comin; A Fertitta; A Prada; G R Passoni; P A Testoni Journal: Am J Gastroenterol Date: 2001-02 Impact factor: 10.864
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Authors: Y Nieto; P Russ; G Everson; S I Bearman; P J Cagnoni; R B Jones; E J Shpall Journal: Bone Marrow Transplant Date: 2000-07 Impact factor: 5.483
Authors: Chi-Liang Cheng; Stuart Sherman; James L Watkins; Jeffrey Barnett; Martin Freeman; Joseph Geenen; Michael Ryan; Harrison Parker; James T Frakes; Evan L Fogel; William B Silverman; Kulwinder S Dua; Giuseppe Aliperti; Paul Yakshe; Michael Uzer; Whitney Jones; John Goff; Laura Lazzell-Pannell; Abdullah Rashdan; M'hamed Temkit; Glen A Lehman Journal: Am J Gastroenterol Date: 2006-01 Impact factor: 10.864
Authors: Jo Vandervoort; Roy M Soetikno; Tony C K Tham; Richard C K Wong; Angelo P Ferrari; Henry Montes; Alfred D Roston; Adam Slivka; David R Lichtenstein; Frederick W Ruymann; Jacques Van Dam; Mike Hughes; David L Carr-Locke Journal: Gastrointest Endosc Date: 2002-11 Impact factor: 9.427