• Ji Won Yoo, Ji Kon Ryu, Sang Hyub Lee, Sang Myung Woo, Joo Kyung Park, Won Jae Yoon, Jun Kyu Lee, Kwang Hyuck Lee, Jin-Hyeok Hwang, Yong-Tae Kim, and Yong Bum Yoon.
• Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
• Pancreas. 2008 Nov 1; 37 (4): 366-70.

ObjectivesPrevious studies have shown that ulinastatin may be effective at preventing pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP). However, routine administration of ulinastatin is unlikely to be cost-effective. So the aim of this prospective study was to evaluate the effectiveness of low-dose ulinastatin at preventing pancreatitis in patients at high risk of post-ERCP pancreatitis.MethodsA total of 227 patients (mean age, 63 years; 54% men) were randomized to receive placebo (n = 108) or active drug (n = 119) immediately after ERCP and received active drug (100,000 U of ulinastatin) or placebo. Occurrence of post-ERCP pancreatitis and hyperamylasemia were compared between the 2 groups.ResultsThe overall incidence of pancreatitis was 6.2%, and no significant differences were observed between placebo- and ulinastatin-treated patients in terms of the frequencies of pancreatitis (5.6% vs 6.7%), abdominal pain, or hyperamylasemia. Pancreatic duct acinarization, papillectomy of ampulla of Vater adenoma, difficult cannulation, and female sex were identified as risk factors for pancreatitis in univariate analysis.ConclusionsLow-dose prophylactic treatment with ulinastatin immediately after ERCP did not show a beneficial influence on the incidence of post-ERCP pancreatitis and hyperamylasemia in high-risk patients.

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