Pretreatment with methylprednisolone to prevent ERCP-induced pancreatitis: A randomized, multicenter, placebo-controlled clinical trial

John A. Dumot, Darwin L. Conwell, J. Barry O'Connor, D. Roy Ferguson, John J. Vargo, David S. Barnes, Steven S. Shay, Mark J. Sterling, Kenneth S. Horth, Khaled Issa, Jeffrey L. Ponsky, Gregory Zuccaro

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54 Scopus citations

Abstract

Objective: Pancreatitis remains the major complication of endoscopic retrograde cholangiopancreatography (ERCP). Uncontrolled data suggest a lower incidence of pancreatitis in patients with a history of iodine sensitivity when given pretreatment with corticosteroids. We conducted a clinical trial to assess the efficacy of a commonly prescribed corticosteroid, methylprednisolone, to prevent ERCP-induced pancreatitis. Methods: Patients were entered into a randomized, multicenter, double-blind, placebo-controlled study of intravenous methylprednisolone (125 mg) versus a saline placebo immediately before the ERCP. All patients were evaluated for early and late complications. Results: Two hundred eighty-six patients were randomized. Thirty-one randomized patients were excluded for technical reasons at the time of ERCP. Overall, the incidence of pancreatitis was 16 of 129 (12.4%, 95% CI: 6.7-18.1%) in the methylprednisolone group and 11 of 126 (8.7%, 95% CI: 4.4-15.1%) in the placebo group, which was not significantly different (p = 0.34). Although there was a higher rate of sphincterotomy performed in the methylprednisolone group compared to the control group (31.8% vs 16.8%, p = 0.005), the incidence of pancreatitis was not different when patients undergoing sphincterotomy were analyzed separately (13.6% in the methylprednisolone group and 9.6% in the placebo group, p = 0.50). There was no significant difference between the two groups for those with ERCP-induced pancreatitis in hospital length of stay (p = 0.22), days of parenteral analgesia (p = 0.09), or days of parenteral nutrition (p = 0.15). Conclusion: Intravenous methylprednisolone is not beneficial in preventing ERCP-induced pancreatitis.

Original languageEnglish
Pages (from-to)61-65
Number of pages5
JournalAmerican Journal of Gastroenterology
Volume93
Issue number1
DOIs
StatePublished - Jan 1998

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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