A review of the rationale for the testing of the calcineurin inhibitor tacrolimus for post-ERCP pancreatitis prevention

Monique T Barakat; Asna Khalid; Mang Yu; Ying Ding; Judy-April Murayi; Thottala Jayaraman; Ronald Poropatich; Venkat Akshintala; Wassem Juakiem; Li Wen; Georgios I Papachristou; Sohail Z Husain

doi:10.1016/j.pan.2022.07.003

A review of the rationale for the testing of the calcineurin inhibitor tacrolimus for post-ERCP pancreatitis prevention

Pancreatology. 2022 Sep;22(6):678-682. doi: 10.1016/j.pan.2022.07.003. Epub 2022 Jul 13.

Authors

Affiliations

¹ Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA; Division of Pediatric Gastroenterology, Hepatology & Nutrition, Lucille Packard Children's Hospital at Stanford, Stanford, CA, USA.
² Division of Pediatric Gastroenterology, Hepatology & Nutrition, Lucille Packard Children's Hospital at Stanford, Stanford, CA, USA.
³ Department of Biostatistics, University of Pittsburgh, Pittsburg, PA, USA.
⁴ Nationwide Children's Hospital, Columbus, OH, USA.
⁵ University of Pittsburgh, School of Dental Medicine, Pittsburg, PA, USA.
⁶ University of Pittsburgh, School of Medicine, Pittsburg, PA, USA.
⁷ Johns Hopkins Medical Institutions, Baltimore, MD, USA.
⁸ Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA.
⁹ Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
¹⁰ The Ohio State University Wexner Medical Center, Columbus, OH, USA.
¹¹ Division of Pediatric Gastroenterology, Hepatology & Nutrition, Lucille Packard Children's Hospital at Stanford, Stanford, CA, USA. Electronic address: [email protected].

PMID: 35872075
DOI: 10.1016/j.pan.2022.07.003

Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) is commonly performed for the management of pancreaticobiliary disorders. The most troublesome ERCP-associated adverse event is post-ERCP pancreatitis (PEP), which occurs in up to 15% of all patients undergoing ERCP. A substantial body of preclinical data support a mechanistic rationale for calcineurin inhibitors in preventing PEP. The findings are coupled with recent clinical data suggesting lower rates of PEP in patients who concurrently use the calcineurin inhibitor tacrolimus (e.g., solid organ transplant recipients). In this review, we will firstly summarize data in support of testing the use of tacrolimus for PEP prophylaxis, either in combination with rectal indomethacin or by itself. Secondly, we propose that administering tacrolimus through the rectal route could be favorable for PEP prophylaxis over other routes of administration.

Keywords: Indomethacin; Pancreatitis; Tacrolimus.

Publication types

Review

MeSH terms

Administration, Rectal
Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
Calcineurin Inhibitors / therapeutic use
Cholangiopancreatography, Endoscopic Retrograde* / adverse effects
Humans
Pancreatitis* / drug therapy
Pancreatitis* / etiology
Pancreatitis* / prevention & control
Risk Factors
Tacrolimus / therapeutic use

Substances

Anti-Inflammatory Agents, Non-Steroidal
Calcineurin Inhibitors
Tacrolimus