The role of oxygen free radicals in the pathogenesis of pancreatitis has been supported in ex-vivo canine models of ischemic, alcoholic, and chemical-induced pancreatitis. (Cameron et al. Surgery 1987;101:342) The present study was designed to determine whether prophylaxis with Allopurinol, an oxygen free radical scavenger, would decrease the incidence of pancreatitis following ERCP in a canine model. Methods: Thirty-two mongrel dogs (15-23kg) were randomly divided to receive either placebo (Group I; n=15) or Allopurinol (Group II; n=17). Allopurinol (Smg/kg) was given orally one hour prior to the procedure. A laparotomy, followed by duodenotomy, was performed to identify and directly cannulate the minor pancreatic duct. Fifteen milliliters of Omniupaque (iohexol) was injected via a 20 gauge catheter. The dogs were allowed to recover and resume a standard diet. Daily serum amylase levels were obtained for five days postoperatively and compared to preoperative values. The dogs were sacrificed on postoperative day five and the pancreases were removed, weighed, and histologically evaluated for parenchymal and peripancreatic injury. Results: Amylase levels, as measured from baseline, were significantly higher in Group I versus Group II on postoperative days 2-5 (p<.025). Amylase levels were three times normal in 5/17 (29.4%) of Group I versus 1/15 (6.67%) of Group II dogs (p< 01). Mean pancreas weight index (pancreas wt/subject wt) was significantly greater in Group 1 versus Group II dogs (p<.002). Parenchymal pancreatic injury was identified histologically in 7/17 (41%) of Group I versus 1/15 (6%) of Group II (p<.01). MEAN AMYLASE CHANGE FROM BASELINE ± SEM POD 1 POD 2 POD 3 POD 4 POD 5 Group I 847±323 582±158*430±107*258±58*280+39*Group II 413±101 213±58 124±71 80±65 3±58*p<.025 for Group I vs Group II Conclusions: Pretreatment with Allopurinol decreases the incidence and severity of post-ERCP pancreatitis in the canine model. These results support the role of xanthine oxidase inhibitors in the prevention of ERCP-induced pancreatitis.
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging