A small dose of somatostatin inhibits the secretin stimulated secretion of bicarbonate, amylase, and chymotrypsin in man

Post-ERCP pancreatitis and its prevention

Pancreatitis remains the most common severe complication of endoscopic retrograde cholangiopancreatography (ERCP), and typically develops in 5-7% of patients. Although most post-ERCP pancreatitis (PEP) is mild, severe pancreatitis and its complications (including a systemic inflammatory response or the development of pseudocysts or pancreatic necrosis) can occur, and in rare cases death can result. A means of preventing PEP in all patients who undergo the procedure remains elusive. Proper patient selection for ERCP is critical to avoid unnecessary risk. Pharmacologic attempts to prevent PEP have been largely unsuccessful; encouraging results have been difficult to validate. Prophylactic stenting of the pancreatic duct and minimally traumatic cannulation techniques offer the most promise as a means of preventing PEP. This manuscript reviews risk factors for PEP as well as pharmacologic and procedural means that can be used to reduce its incidence.

Evaluation of somatostatin inhibitory effect on pancreatic exocrine function using secretin-enhanced dynamic magnetic resonance cholangiopancreatography: a crossover, randomized, double blind, placebo-controlled study

OBJECTIVES

Somatostatin inhibitory effect on the exocrine pancreas has been demonstrated by clinical and experimental studies performed with invasive investigative methods. The aim of this study was to quantify the inhibitory effect of low doses of somatostatin (62.5, 125, and 250 microg) on secretin-stimulated pancreatic exocrine secretions using magnetic resonance cholangiopancreatography (MRCP).

METHODS

Ten healthy volunteers underwent 4 MRCP at a 1-week interval. At each MRCP, 1 of the 3 doses of Somatostatin or the placebo was given by the intravenous route for a period of 40 minutes. After 20 minutes from the beginning of drug infusion, secretin was injected (0.3 CU/kg). MRCP was performed before and every 30 to 45 seconds for 15 minutes after secretin administration. Pancreatic exocrine secretions were quantified by the measurements of pancreatic flow output and total excreted volume, derived from a linear regression between MRCP calculated volumes and time.

RESULTS

For the 3 doses of somatostatin, pancreatic flow output was significantly reduced compared to placebo (P < 0.05). Total excreted volume was significantly reduced only for the doses of 62.5 and 250 microg. No statistical significant differences were observed among the 3 doses.

CONCLUSIONS

Low doses of somatostatin inhibit pancreatic exocrine secretions as demonstrated noninvasively with MRCP.

Role of unlabelled somatostatin analogues in the prevention of complications after elective pancreatic and peripancreatic surgery: a critical review

Although studies on the use of the somatostatin analogues in the elective pancreatic surgery are mostly prospective, double blind and randomised, the results are contradictory and not univocally interpretable. Through the examination of all randomised perspective works published on this subject, a critical interpretation is attempted which may give relevant suggestions for further studies. A new clinical, randomised, double blind and multicentric prospective trial should take into proper consideration even the changes which have occurred in the care of the patients. Over the years a significant decrease of postoperative hospital stay and a deeper awareness of the medical expenses have been observed. Moreover, since the drug has a potential advantage on specific pancreatic complications, only these must be considered among the end points of the study and the population studied will be limited exclusively to patients who underwent resection of the pancreatic head or of the periampullar region because of neoplastic disease. Finally, the selection of the centres that enrol the patients must be considered, since the expertise of each operator or of the team, affects, as an independent variable, both morbidity and mortality.