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KMID : 1038120220550050665
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Clinical Endoscopy
2022 Volume.55 No. 5 p.665 ~ p.673
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Preventive effect of tacrolimus on patients with post-endoscopic retrograde cholangiopancreatography pancreatitis
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Harshavardhan Rao B.
Vincent Paul K.
Nair Priya
Koshy Anoop K.
Venu Rama P.
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Abstract
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Background/Aims: In patients undergoing endoscopic retrograde cholangiopancreatography (ERCP), calcineurin activates zymogen, which results in pancreatitis. In this study, we aimed to determine the efficacy of tacrolimus, a calcineurin inhibitor, in preventing post-ERCP pancreatitis (PEP).
Methods: This was a prospective pilot study in which patients who underwent ERCP received tacrolimus (4 mg in two divided doses); this was the Tac group. A contemporaneous cohort of patients was included as a control group. All patients were followed-up for PEP. PEP was characterized by worsening abdominal pain with an acute onset, elevated pancreatic enzymes, and a duration of hospital stay of more than 48 hours. Serum tacrolimus levels were measured immediately before the procedure in the Tac group.
Results: There were no differences in the baseline characteristics between the Tac group (n=48) and the control group (n=51). Only four out of 48 patients (8.3%) had PEP in the Tac group compared to eight out of 51 patients (15.7%) who had PEP in the control group. The mean trough tacrolimus level in patients who developed PEP was significantly lower (p<0.05).
Conclusions: Oral tacrolimus at a cumulative dose of 4 mg safely prevents PEP. Further randomized controlled studies are warranted to establish the role of tacrolimus in this context.
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KEYWORD
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Calcineurin, Endoscopic retrograde cholangiopancreatography, Pancreatitis, Prophylaxis, Tacrolimus
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