Bexelius TS, Blomberg J, Lu YX, Håkansson HO, Möller P, Nordgren CE, Arnelo U, Lagergren J, Lindblad M. Losartan to prevent hyperenzymemia after endoscopic retrograde cholangiopan-creatography: A randomized clinical trial. World J Gastrointest Endosc 2012; 4(11): 506-512 [PMID: 23189222 DOI: 10.4253/wjge.v4.i11.506]
Corresponding Author of This Article
Tomas Sjöberg Bexelius, MD, PhD, Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Norra Stationsgatan 67, 176 70 Stockholm, Sweden. tomas.s.bexelius@ki.se
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World J Gastrointest Endosc. Nov 16, 2012; 4(11): 506-512 Published online Nov 16, 2012. doi: 10.4253/wjge.v4.i11.506
Losartan to prevent hyperenzymemia after endoscopic retrograde cholangiopan-creatography: A randomized clinical trial
Tomas Sjöberg Bexelius, John Blomberg, Yun-Xia Lu, Hans-Olof Håkansson, Peter Möller, Carl-Eric Nordgren, Urban Arnelo, Jesper Lagergren, Mats Lindblad
Tomas Sjöberg Bexelius, John Blomberg, Yun-Xia Lu, Jesper Lagergren, Mats Lindblad, Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, 176 70 Stockholm, Sweden
John Blomberg, Urban Arnelo, Mats Lindblad, Department of Surgery, Gastro Center, Karolinska University Hospital, 176 70 Stockholm, Sweden
Hans-Olof Håkansson, Peter Möller, Carl-Eric Nordgren, Department of Surgery, Kalmar County Hospital, 391 85 Kalmar, Sweden
Urban Arnelo, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, 176 70 Stockholm, Sweden
Author contributions: Bexelius TS conceived the study and performed the study design and drafted the manuscript; Blomberg J performed endoscopies and wrote the manuscript; Lu YX performed the statistical analysis and helped with the study design; Arnelo U, Håkansson HO and Möller P recruited patients, performed endoscopies and revised the manuscript; Nordgren CE contributed to manuscript writing; Lagergren J conceived the study, its design and edited the manuscript; Lindblad M concieved the study, performed endoscopies, and aided in writing the manuscript; All authors read and approved the final manuscript.
Supported by The Swedish Society of Medicine, The Lisa and Johan Grönberg Foundation
Correspondence to: Tomas Sjöberg Bexelius, MD, PhD, Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Norra Stationsgatan 67, 176 70 Stockholm, Sweden. tomas.s.bexelius@ki.se
Telephone: +46-8-517769-40 Fax: +46-8-51776280
Received: August 30, 2011 Revised: August 27, 2012 Accepted: October 26, 2012 Published online: November 16, 2012
Abstract
AIM: To study if the angiotensin II receptor blockers (ARB) losartan counteracts pancreatic hyperenzymemia as measured 24 h after endoscopic retrograde cholangiopancreatography (ERCP).
METHODS: A triple-blind and placebo-controlled randomized clinical trial was performed at two Swedish hospitals in 2006-2008. Patients over 18 years of age undergoing ERCP, excluding those with current pancreatitis, current use of ARB, and severe disease, such as sepsis, liver and renal failure. One oral dose of 50 mg losartan or placebo was given one hour before ERCP. The relative risk of hyperenzymemia 24 h after ERCP was estimated using multivariable logistic regression, and expressed as odds ratio with 95% confidence intervals (CIs), including adjustment for potential remaining confounding.
RESULTS: Among 76 participating patients, 38 were randomized to the losartan and the placebo group, respectively. The incidence rates of hyperenzymemia and acute pancreatitis among all 76 participating patients were 21% and 12%, respectively. Hyperenzymemia was detected in 9 and 7 patients in the losartan and placebo group, respectively. There were no major differences between the comparison groups regarding cannulation difficulty, findings, or proportion of patients requiring drainage of the bile ducts. There were, however, more pancreatic duct injections, a greater extent of pancreatography, and more biliary sphincterotomies in the losartan group than in the placebo group. Losartan was not associated with risk of hyperenzymemia compared to the placebo group after multi-varible logistic regression analysis (odds ratio 1.6, 95%CI 0.3-7.8).
CONCLUSION: In this randomized trial 50 mg losartan given orally had no prophylactic effect on development of hyperenzymemia after ERCP.
