COMPARATIVE STUDY BETWEEN URINASTATIN AND NAFAMOSTAT MESYLATE FOR THE PREVENTION OF POST-ERCP PANCREATITIS

Aims A pancreatitis is a major complication of ERCP. Nafamostat mesylate (Futhan) and Urinastatin (Ulistin) are commonly used to prevent and treat pancreatitis in Korea. The aim of our study is to compare the efficacy of Nafamostat Mesilate and Urinastatin for post ERCP pancreatitis (PEP) prevention.

Methods From January 2016 to April 2019, a total of 1797 patients who underwent ERCP were analyzed. Patients received continuous infusion of 500 mL of 5% dextrose solution with 50 mg of nafamostat mesylate (1175 patients) or with 150,000 unit of Urinastatin (622 patients). PEP is diagnosed if two of the following three criteria is present; pain consistent with acute pancreatitis, raised serum amylase or lipase levels more than three times normal, and typical imaging findings.

Results There was a significant difference in the incidence of PEP between the Nafamostat mesylate and Urinastatin groups (4.1% vs 2.1%; odds ratio 0.5; 95% confidence interval 0.3 to 0.9, P = 0.03). Risk factors of PEP were a previous history of PEP, difficult cannulation defined as multiple pancreatic duct cannulation > 3 times or cannulation procedure time > 5 min, nafamostat mesylate use.

Conclusions Urinastatin prophylaxis is more effective in prevention of post-ERCP pancreatitis compared to Nafamostat mesylate.