Abstract / Summary
Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis is the most frequent complication of ERCP. Systemic corticosteroids have not shown consistent preventive benefit, and local intraductal delivery has not been evaluated. Twenty-eight female Wistar albino rats were randomly allocated to four groups ( n = 7): control, transduodenal cholangiopancreatography (TDCP) + saline, TDCP + contrast, and TDCP + contrast + steroid. The contrast group received 0.5 mL of 50% diluted contrast intraductally; the steroid group received the same injection followed 10 min later by a separate 0.5 mL injection of methylprednisolone (approximately 1 mg/kg). These protocols differed in injection number and total intraductal volume; their comparison is therefore exploratory rather than methylprednisolone-specific. Primary endpoints were the Schoenberg histopathological score and serum amylase at 24 h; secondary endpoints were 13 cytokines and chemokines. Effect estimates are reported as Hodges–Lehmann (HL) shifts with exact 95% confidence intervals and Benjamini–Hochberg-adjusted P values. Contrast injection produced pancreatic injury versus control (Schoenberg HL 5.0, 95% CI 2.0 to 6.0; adjusted P = 0.005). Compared with contrast alone, the steroid group had lower amylase (1846 vs. 3520 U/L; HL − 1591, 95% CI − 2543 to − 709; adjusted P = 0.005) and CXCL-1 (1009 vs. 2549 pg/mL; HL − 1638, 95% CI − 3621 to − 703; adjusted P = 0.010). Histopathological scores did not differ (HL − 1.0, 95% CI − 3.0 to 1.0; adjusted P = 0.495). Differences in MCP-1, IL-6 and IL-1β were not significant after adjustment. Four cytokines were unquantifiable in all animals. Intraductal methylprednisolone after contrast injection was associated with lower serum amylase and CXCL-1, but no histopathological benefit was demonstrated. These findings are hypothesis-generating and require a contrast-plus-vehicle control.