Intrapancreatic dexamethasone does not prevent sphincterotomy-induced pancreatitis in a canine model

Pankaj Jay Pasricha, S. L. Hill, R. L. Huang, R. Aggarwal, C. A. Magee, Anthony N Kalloo

Research output: Contribution to journalArticle

Abstract

Acute pancreatitis is a common and potentially serious complication of ERCP. While the exact pathogenesis of ERCP-induced pancreatitis is unknown, retrospective data has suggested that the use of steroids before ERCP may reduce the incidence of pancreatitis. On the other hand, steroids have also been implicated in the pathogenesis of acute pancreatitis in some patients. Therefore, the use of steroids for prophylaxis against ERCP-induce pancreatitis has the potential for both beneficial and harmful effects. Methods. We studied the effects of directly administering steroids to the pancreas just before the inciting injury in a newly developed dog model of sphincterotomy-induced pancreatitis. 8 semi-conditioned mongrel dogs underwent ERCP after sedation with acepromazine and pentobarbital. After free cannulation of the minor papilla by a blinded endoscopist, dogs were randomized into two groups. In group 1 (placebo) 4.5 ml of contrast + 0.5 ml saline was injected into the main pancreatic duct under constant pressure until acinarization was achieved. Animals in group 2 were injected identically with 4.5 ml of contrast + 0.5 ml of dexamethasone (containing 5 mg of the steroid). Thereafter, all dogs underwent papillotomy of both the minor and major papillae. 24 hours later the pancreas were harvested and examined by a blinded pathologist. Pancreatitis was graded histologically on a scale of 0-4 for edema, polymorphonuclear cell infiltrate, intraparenchymal hemorrhage, parenchymal necrosis and vacuolization of acinar cells. Results A significant elevation in serum amylase was seen 1 hour after sphincterotomy in the dexamethasone group (852 vs 596;P=0.01) but not in the placebo group. However, there were no significant differences in total inflammatory scores between the two groups at 24 hours (7 vs 12;P=0.34). Conclusions. Intrapancreatic instillation of dexamethasone does not appear to be effective in preventing sphincterotomy induced pancreatitis and has the potential for worsening hyperamylasemia.

Original languageEnglish (US)
Pages (from-to)391
Number of pages1
JournalGastrointestinal Endoscopy
Volume43
Issue number4
StatePublished - 1996

Fingerprint

Pancreatitis
Dexamethasone
Canidae
Endoscopic Retrograde Cholangiopancreatography
Steroids
Dogs
Pancreas
Acepromazine
Placebos
Hyperamylasemia
Acinar Cells
Pancreatic Ducts
Pentobarbital
Amylases
Catheterization
Edema
Necrosis
Hemorrhage
Pressure
Incidence

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Intrapancreatic dexamethasone does not prevent sphincterotomy-induced pancreatitis in a canine model. / Pasricha, Pankaj Jay; Hill, S. L.; Huang, R. L.; Aggarwal, R.; Magee, C. A.; Kalloo, Anthony N.

In: Gastrointestinal Endoscopy, Vol. 43, No. 4, 1996, p. 391.

Research output: Contribution to journalArticle

@article{e838cf98d5c04797beff56ba54e2fbcf,
title = "Intrapancreatic dexamethasone does not prevent sphincterotomy-induced pancreatitis in a canine model",
abstract = "Acute pancreatitis is a common and potentially serious complication of ERCP. While the exact pathogenesis of ERCP-induced pancreatitis is unknown, retrospective data has suggested that the use of steroids before ERCP may reduce the incidence of pancreatitis. On the other hand, steroids have also been implicated in the pathogenesis of acute pancreatitis in some patients. Therefore, the use of steroids for prophylaxis against ERCP-induce pancreatitis has the potential for both beneficial and harmful effects. Methods. We studied the effects of directly administering steroids to the pancreas just before the inciting injury in a newly developed dog model of sphincterotomy-induced pancreatitis. 8 semi-conditioned mongrel dogs underwent ERCP after sedation with acepromazine and pentobarbital. After free cannulation of the minor papilla by a blinded endoscopist, dogs were randomized into two groups. In group 1 (placebo) 4.5 ml of contrast + 0.5 ml saline was injected into the main pancreatic duct under constant pressure until acinarization was achieved. Animals in group 2 were injected identically with 4.5 ml of contrast + 0.5 ml of dexamethasone (containing 5 mg of the steroid). Thereafter, all dogs underwent papillotomy of both the minor and major papillae. 24 hours later the pancreas were harvested and examined by a blinded pathologist. Pancreatitis was graded histologically on a scale of 0-4 for edema, polymorphonuclear cell infiltrate, intraparenchymal hemorrhage, parenchymal necrosis and vacuolization of acinar cells. Results A significant elevation in serum amylase was seen 1 hour after sphincterotomy in the dexamethasone group (852 vs 596;P=0.01) but not in the placebo group. However, there were no significant differences in total inflammatory scores between the two groups at 24 hours (7 vs 12;P=0.34). Conclusions. Intrapancreatic instillation of dexamethasone does not appear to be effective in preventing sphincterotomy induced pancreatitis and has the potential for worsening hyperamylasemia.",
author = "Pasricha, {Pankaj Jay} and Hill, {S. L.} and Huang, {R. L.} and R. Aggarwal and Magee, {C. A.} and Kalloo, {Anthony N}",
year = "1996",
language = "English (US)",
volume = "43",
pages = "391",
journal = "Gastrointestinal Endoscopy",
issn = "0016-5107",
publisher = "Mosby Inc.",
number = "4",

}

TY - JOUR

T1 - Intrapancreatic dexamethasone does not prevent sphincterotomy-induced pancreatitis in a canine model

AU - Pasricha, Pankaj Jay

AU - Hill, S. L.

AU - Huang, R. L.

AU - Aggarwal, R.

AU - Magee, C. A.

AU - Kalloo, Anthony N

PY - 1996

Y1 - 1996

N2 - Acute pancreatitis is a common and potentially serious complication of ERCP. While the exact pathogenesis of ERCP-induced pancreatitis is unknown, retrospective data has suggested that the use of steroids before ERCP may reduce the incidence of pancreatitis. On the other hand, steroids have also been implicated in the pathogenesis of acute pancreatitis in some patients. Therefore, the use of steroids for prophylaxis against ERCP-induce pancreatitis has the potential for both beneficial and harmful effects. Methods. We studied the effects of directly administering steroids to the pancreas just before the inciting injury in a newly developed dog model of sphincterotomy-induced pancreatitis. 8 semi-conditioned mongrel dogs underwent ERCP after sedation with acepromazine and pentobarbital. After free cannulation of the minor papilla by a blinded endoscopist, dogs were randomized into two groups. In group 1 (placebo) 4.5 ml of contrast + 0.5 ml saline was injected into the main pancreatic duct under constant pressure until acinarization was achieved. Animals in group 2 were injected identically with 4.5 ml of contrast + 0.5 ml of dexamethasone (containing 5 mg of the steroid). Thereafter, all dogs underwent papillotomy of both the minor and major papillae. 24 hours later the pancreas were harvested and examined by a blinded pathologist. Pancreatitis was graded histologically on a scale of 0-4 for edema, polymorphonuclear cell infiltrate, intraparenchymal hemorrhage, parenchymal necrosis and vacuolization of acinar cells. Results A significant elevation in serum amylase was seen 1 hour after sphincterotomy in the dexamethasone group (852 vs 596;P=0.01) but not in the placebo group. However, there were no significant differences in total inflammatory scores between the two groups at 24 hours (7 vs 12;P=0.34). Conclusions. Intrapancreatic instillation of dexamethasone does not appear to be effective in preventing sphincterotomy induced pancreatitis and has the potential for worsening hyperamylasemia.

AB - Acute pancreatitis is a common and potentially serious complication of ERCP. While the exact pathogenesis of ERCP-induced pancreatitis is unknown, retrospective data has suggested that the use of steroids before ERCP may reduce the incidence of pancreatitis. On the other hand, steroids have also been implicated in the pathogenesis of acute pancreatitis in some patients. Therefore, the use of steroids for prophylaxis against ERCP-induce pancreatitis has the potential for both beneficial and harmful effects. Methods. We studied the effects of directly administering steroids to the pancreas just before the inciting injury in a newly developed dog model of sphincterotomy-induced pancreatitis. 8 semi-conditioned mongrel dogs underwent ERCP after sedation with acepromazine and pentobarbital. After free cannulation of the minor papilla by a blinded endoscopist, dogs were randomized into two groups. In group 1 (placebo) 4.5 ml of contrast + 0.5 ml saline was injected into the main pancreatic duct under constant pressure until acinarization was achieved. Animals in group 2 were injected identically with 4.5 ml of contrast + 0.5 ml of dexamethasone (containing 5 mg of the steroid). Thereafter, all dogs underwent papillotomy of both the minor and major papillae. 24 hours later the pancreas were harvested and examined by a blinded pathologist. Pancreatitis was graded histologically on a scale of 0-4 for edema, polymorphonuclear cell infiltrate, intraparenchymal hemorrhage, parenchymal necrosis and vacuolization of acinar cells. Results A significant elevation in serum amylase was seen 1 hour after sphincterotomy in the dexamethasone group (852 vs 596;P=0.01) but not in the placebo group. However, there were no significant differences in total inflammatory scores between the two groups at 24 hours (7 vs 12;P=0.34). Conclusions. Intrapancreatic instillation of dexamethasone does not appear to be effective in preventing sphincterotomy induced pancreatitis and has the potential for worsening hyperamylasemia.

UR - http://www.scopus.com/inward/record.url?scp=4243304807&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=4243304807&partnerID=8YFLogxK

M3 - Article

VL - 43

SP - 391

JO - Gastrointestinal Endoscopy

JF - Gastrointestinal Endoscopy

SN - 0016-5107

IS - 4

ER -