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Paul K. Vincent 1 Article
Preventive effect of tacrolimus on patients with post-endoscopic retrograde cholangiopancreatography pancreatitis
Harshavardhan Rao B., Paul K. Vincent, Priya Nair, Anoop K. Koshy, Rama P. Venu
Clin Endosc 2022;55(5):665-673.   Published online August 2, 2022
DOI: https://doi.org/10.5946/ce.2021.265
AbstractAbstract PDFPubReaderePub
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.

Citations

Citations to this article as recorded by  
  • Acute pancreatitis: pathogenesis and emerging therapies
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    Journal of Pancreatology.2024; 7(1): 10.     CrossRef
  • Preclinical safety evaluation of calcineurin inhibitors delivered through an intraductal route to prevent post-ERCP pancreatitis demonstrates endocrine and systemic safety
    Jianbo Ni, Asna Khalid, Yu-Chu Lin, Monique T. Barakat, Jing Wang, Cheng-Yu Tsai, Pasha Reza Shams Azar, Ying Ding, Judy-April Murayi, Thottala Jayaraman, Ronald Poropatich, Rita Bottino, Li Wen, Georgios I. Papachristou, Gayathri Swaminathan, Mang Yu, So
    Pancreatology.2023; 23(4): 333.     CrossRef
  • Could assessment of genetic susceptibility be an effective solution to prevent pancreatitis from occurring after endoscopic retrograde cholangiopancreatography?
    Jae Min Lee
    The Korean Journal of Internal Medicine.2023; 38(6): 783.     CrossRef
  • Rectal administration of tacrolimus protects against post-ERCP pancreatitis in mice
    Yu-Chu Lin, Jianbo Ni, Gayathri Swaminathan, Asna Khalid, Monique T. Barakat, Adam R. Frymoyer, Cheng-Yu Tsai, Ying Ding, Judy-April Murayi, Thottala Jayaraman, Ronald Poropatich, Rita Bottino, Li Wen, Georgios I. Papachristou, Sunil G. Sheth, Mang Yu, So
    Pancreatology.2023; 23(7): 777.     CrossRef
  • Tacrolimus for prophylaxis of post-endoscopic retrograde cholangiopancreatography pancreatitis: a potential new target of old drug?
    Seok Jeong
    Clinical Endoscopy.2022; 55(5): 628.     CrossRef
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