Table 2.

Pharmacalogical prevention of post-ERCP pancreatitis: targeted mechanisms, drug tested, quality of evidence, and overall results¹

Mechanism	Drug	Evidence	Average risk patients	High risk patients
Sphincter spasm	Ca++ channel blocker Lidocaine (topical) Nitroglycerine	B B B	Ineffective Ineffective Possibly effective in high dose	No data No data Ineffective
Infection	Antibiotics	B	Possible effective	No data
Contrast	Nonionic contrast	A	Ineffective	Ineffective
Toxicity	Corticosteroids	A	Ineffective	Ineffective
Inflammatory	Allopurinol	B	Ineffective	Ineffective
	PAF inhibitors	A	Ineffective	Ineffective
Cascade	IL-10	B	Ineffective	Ineffective
	Heparin derivatives	A	Ineffective	Ineffective
	NSAID	B	Possibly effective	No data
	Gabexate	A	Ineffective (≤ 6 h infusion)	Ineffective
		A	Effective (12-h infusion)	No data
Pancreatic secretions	Octreotide	A	Ineffective	No data
	Somatostatin	A	Ineffective (≤ 6-h infusion)	No data
		B	Possibly effective (12-24 h infusion)

PAF: Platelet activating factor; IL-10: interleukin 10; NSAID: non-steroidal anti-inflammatory drug. The level of evidence was graded by using a system adapted from Cook et al 17 as follows: Grade A supported by two or more randomized trials with P values < 0.05, appropriate methodology, and no conflicting results in the trials; Grade B supported by randomized trials with P values > 0.05, and/or inappropriate methodology, and/or inadequate sample sizes, and/or conflicting results among the trials; Grade C supported by non-randomized trials. ¹Adapted from Freeman and Guda[5].