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Superior Control of Nocturnal Gastric-Acid Secretion by the Novel RESEARCH HIGHLIGHTS www.nature.com/clinicalpractice/gasthep GLOSSARY Superior control of nocturnal Gastrointestinal Endoscopy has pub- ENDOSCOPIC gastric-acid secretion by the lished guidelines on the use of endoscopic RETROGRADE ultrasonography (EUS) and ENDOSCOPIC CHOLANGIO- novel proton-pump inhibitor, PANCREATOGRAPHY tenatoprazole RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP) (ERCP) in the diagnosis and treatment of pancreatic Endoscopic technique of injecting contrast dye into Proton-pump inhibitors (PPIs) effectively prevent cystic lesions and fluid collections. Cystic pan- the ampulla of Vater for gastric-acid secretion and are used to control the creatic lesions encompass a number of benign radiologic visualization of the pancreatic and biliary symptoms of various acid-related gastrointestinal and malignant masses. Pancreatic fluid collec- ducts diseases. These compounds have a short plasma tions (PFCs) develop secondary to pancreati- half-life, however, which limits the efficacy of a tis and pancreatic trauma and typically resolve single dose. The novel PPI tenatoprazole, an without intervention. imidazopyridine derivative, benefits from an The guidelines state that although EUS is not extended plasma half-life and could negate the a reliable basis for treatment decision making, requirement for repeated dosing. Galmiche et al. it can help to differentiate between types of have recently compared the effects of tenatopra- pancreatic cystic lesions and to guide fine- zole with esomeprazole, a benzimidazole-derived needle aspiration of lesions. Levels of enzymes PPI, on intragastric pH in healthy subjects. and tumor markers in pancreatic cysts are not The randomized, two-period crossover study specific enough to identify malignancy or to recruited 24 healthy, male volunteers from a distinguish a particular type of lesion; however, French academic institution. All subjects had cytologic analysis of cyst fluid can aid diag- no history of gastrointestinal disease and tested nosis of pseudocysts, malignancy, and muci- negative for Helicobacter pylori, HIV, and hepa- nous or serous cystadenomas. ERCP can also titis B and C. Volunteers received either 40 mg reveal signs characteristic of malignancy. tenatoprazole (T40) or esomeprazole 40 mg (E40) Although endoscopy is not used to treat neo- once daily for 2 consecutive days and, after a 2- plastic cystic lesions, the guidelines advocate week interim period, changed to the other regi- endoscopic drainage as an alternative to surgi- men. All volunteers were hospitalized and intra- cal or percutaneous drainage of inflammatory gastric pH was monitored every 5 s during the PFCs. EUS or ERCP evaluation is suggested 48-hour dosing period. Nocturnal pH levels were before drainage. significantly higher on both the first and second Further prospective controlled trials are days in subjects receiving T40 when compared warranted to clarify the exact role of EUS and with those receiving E40, although this effect ERCP in the diagnosis and management of was not observed diurnally. T40 was also sig- pancreatic cystic lesions and PFCs. In the nificantly more effective than E40 at reducing meantime, however, the new guidelines rec- the duration of nocturnal acid breakthroughs. ommend that, with appropriate antibiotic The time needed to reach a sustained increase prophylaxis, these techniques have utility in in intragastric pH was, however, comparable for this setting. both drugs. The authors conclude that tenato- prazole is a potent acid suppressor and, in the Original article Jacobson BC et al.; American Society for Gastrointestinal Endoscopy (2005) ASGE guideline: the role first 48 h, exerts significantly better control over of endoscopy in the diagnosis and the management of cystic nocturnal intragastric pH than esomeprazole. lesions and inflammatory fluid collections of the pancreas. Gastrointest Endosc 61: 363–370 Original article Galmiche JP et al. (2005) A comparative study of the early effects of tenatoprazole 40 mg and esomeprazole 40 mg on intragastric pH in healthy volunteers. Aliment Pharmacol Ther 21: 575–582 Does high-dose allopurinol prevent post-ERCP pancreatitis? New guidelines on endoscopic diagnosis and management of Allopurinol inhibits the generation of oxygen- pancreatic cystic masses derived free radicals and it has been postulated that this xanthine oxidase inhibitor might pre- Based on expert opinion and analysis of vent post-endoscopic retrograde cholangio- existing data, the American Society for pancreatography (ERCP) pancreatitis. Despite 202 NATURE CLINICAL PRACTICE GASTROENTEROLOGY & HEPATOLOGY MAY 2005 VOL 2 NO 5 © 2005 Nature Publishing Group.
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