The effect of epinephrine spray on prevention of Post-Endoscopic Retrograde Cholangiopancreatography (ERCP) pancreatitis

Abstract

Background: Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is one of the life-threatening complications of ERCP. Numerous efforts have been made to decrease the risk of PEP; however, the results were controversial. The current study aimed to assess the efficacy of local epinephrine spray on PEP reduction. Methods: 124 patients undergone ERCP were randomly divided into two groups of intervention (n = 67) and control (n = 57). The intervention group was treated with 20 ml of local epinephrine 0.02 on papilla immediately after ERCP, and the controls with similar volume of normal saline. Demographic factors, procedure-related factors (duration of procedure, volume of contrast, times of cannulation, precut sphinctrotomy, billiary balloon dilatation, asinarization, opacification, and number of pancreatic duct cannulations), as well as amylase, lipase, and hemoglobin levels at baseline and within 24 hour after the procedure were compared between the groups. Besides, the patients were assessed in terms of pancreatitis, bleeding, and perforation incidence within 12 and 24 hours after ERCP. Findings: The two assessed groups were similar in terms of demographic and procedural-related factors (P > 0.050). Pancreatitis occurred in 1 patient (1.5) in intervention and 6 ones (10.5) in control group (P = 0.036). The two groups were not statistically different in terms of amylase and lipase at baseline and after ERCP. Bleeding occurred only a case (1.75) in the control group and no one experienced perforation. Conclusion: Based on the findings of the current study, local epinephrine spray can remarkably lead to decreased pancreatitis incidence as compared to the control group; however, it cannot significantly affect the pancreatic enzymes level and pancreatitis severity. © 2021 Isfahan University of Medical Sciences(IUMS). All rights reserved.