Abstract
Acute pancreatitis is the most common iatrogenic dilemma of endoscopic retrograde
cholangiopancreatography, and it is associated with significant morbidity and mortality.
Several factors have been implicated in the pathogenesis of post-endoscopic retrograde
cholangiopancreatography pancreatitis, and preventive measures were practiced accordingly.
This study aims to refine the potential mechanisms that trigger post-endoscopic retrograde
cholangiopancreatography pancreatitis and define the role of enteropeptidase in the
pathogenesis of post-endoscopic retrograde cholangiopancreatography pancreatitis.
Furthermore, address the role of a new novel medication known as SCO-792, a potent
enteropeptidase inhibitor, in the prevention of post-endoscopic retrograde cholangiopancreatography
(ERCP) pancreatitis.
Post-endoscopic retrograde cholangiopancreatography pancreatitis is caused by premature
activation of the pancreatic enzymes within the pancreatic parenchyma. This activation
is either an autoactivation due to direct provocation of intra-acinar enzymes as a
result of the procedure or due to activation by enterpeptidase, a rate-limiting enzyme.
Endoscopic retrograde cholangiopancreatography interjects duodenal juice that is rich
in enterokinase into the pancreatic-biliary tract, which in turn leads to intra-ductal
activation of trypsinogen and subsequent enzymes. Given the vital role of enterokinase
in initiating the pathogenesis of pancreatitis, enteropeptidase inhibition may prevent
and reduce the severity of post-endoscopic retrograde cholangiopancreatography pancreatitis.
SCO-792, a novel enteropeptidase inhibitor, is developed by SCOHIA Pharma, and pre-clinical
trials confirmed its efficacy in inhibiting enteropeptidase. Studies are needed to
confirm the efficacy of enteropeptidase inhibitors in preventing post-endoscopic retrograde
cholangiopancreatography pancreatitis.
Keywords
pancreatitis - ERCP - post-ERCP pancreatitis - enteropeptidase - SCO-792
