Role of ulinastatin in preventing post-endoscopic retrograde cholangiopancreatography pancreatitis: the Emperor's New Clothes or Aladdin's Magic Lamp?

Pancreas. 2010 Nov;39(8):1231-7. doi: 10.1097/MPA.0b013e3181dc67e7.

Abstract

Objectives: The role of prophylactic ulinastatin in the prevention of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis is debated. A meta-analysis of all published randomized clinical trials was performed to evaluate the efficacy of ulinastatin on post-ERCP pancreatitis.

Methods: Searches were conducted in multiple databases composed of PubMed, EMBASE, the Cochrane Library, the Science Citation Index Expanded, and the China National Knowledge Infrastructure series full-text database. Primary outcome was post-ERCP pancreatitis, with or without hyperamylasemia.

Results: Seven randomized clinical trials fulfilling the inclusion criteria were selected for meta-analysis, 5 comparing ulinastatin with placebo and 2 for ulinastatin versus gabexate. The incidence of post-ERCP pancreatitis was reduced by ulinastatin (odds ratio, 0.53; 95% confidence interval, 0.31-0.89; P = 0.02; test for heterogeneity: I = 0%; P = 0.51), so was the event of hyperamylasemia (odds ratio, 0.42; 95% confidence interval, 0.30-0.59; P < 0.00001; test for heterogeneity: I = 13%; P = 0.33). Subsequent sensitivity and subgroup analyses produced conflicting results.

Conclusions: Ulinastatin shows to be of value on preventing post-ERCP pancreatitis and hyperamylasemia for patients in average risk, when given intravenously at a dose of not less than 150,000 U, just before ERCP. More high-quality trials are needed for further confirmation.

Publication types

  • Meta-Analysis

MeSH terms

  • Cholangiopancreatography, Endoscopic Retrograde / adverse effects*
  • Glycoproteins / therapeutic use*
  • Humans
  • Hyperamylasemia / etiology
  • Hyperamylasemia / prevention & control
  • Pancreatitis / etiology
  • Pancreatitis / prevention & control*
  • Randomized Controlled Trials as Topic
  • Trypsin Inhibitors / therapeutic use

Substances

  • Glycoproteins
  • Trypsin Inhibitors
  • urinastatin