Reply to Kakutani et al.

We have read the letter by Kakutani et al. in the current issue. While we understand and appreciate their ethical concerns surrounding our recent publication in Endoscopy attempting to establish an animal model of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) [1], we strongly disagree with their position. In their own words, PEP continues to be “one of the most severe complications of interventional endoscopy,” affecting between 1 % and 22 % [2] [3] [4] of all patients undergoing ERCP. With the exception of pancreatic stent placement [5] [6], all other measures studied for the prevention of this disease have proven to be less effective. The cost, morbidity, and mortality associated with PEP is unacceptable, yet the practice of “pilot testing” unproven agents, maneuvers, or devices in humans should stop. As such, we firmly believe that an animal model mimicking PEP would serve as an invaluable platform for the initial study of pharmaceuticals and devices aimed at its prevention, thereby avoiding the wasteful use of resources while studying ineffective measures in humans. We strongly support thoughtful and ethical research in the prevention of PEP, and it is for this reason that our study was designed and carried forward under strict approval from our institution’s animal research review board – not for the sole purpose of obtaining “academic kudos.”

Competing interests: None

References

• 1 Buscaglia J M, Simons B W, Prosser B J. et al . Severity of post-ERCP pancreatitis directly proportional to the invasiveness of endoscopic intervention: a pilot study in a canine model.  Endoscopy. 2008;  40 506-512
• 2 Marks J M, Dunkin B J, Shillingstad B L. et al . Pretreatment with allopurinol diminishes pancreatography-induced pancreatitis in a canine model.  Gastrointest Endosc. 1998;  48 180-183
• 3 Freeman M L, Nelson D B, Sherman S. et al . Complications of endoscopic biliary sphincterotomy.  N Engl J Med. 1996;  335 909-918
• 4 Bilbao M K, Dotter C T, Lee T G. et al . Complications of endoscopic retrograde cholangiopancreatography (ERCP). A study of 10,000 cases.  Gastroenterology. 1976;  70 314-320
• 5 Tarnasky P R, Palesch Y Y, Cunningham J T. et al . Pancreatic stenting prevents pancreatitis after biliary sphincterotomy in patients with sphincter of Oddi dysfunction.  Gastroenterology. 1998;  115 1518-1524
• 6 Tarnasky P R. Mechanical prevention of post-ERCP pancreatitis by pancreatic stents: results, techniques, and indications.  JOP. 2003;  4 58-67