Efficacy Versus Effectiveness of Octreotide in the Prophylaxis of Post-ERCP Pancreatitis

TO THE EDITOR: We read with interest the results of the randomized trial carried out by Li et al. on the prophylactic benefit of octreotide administration in reducing pancreatic damage after ERCP (1). In this study, the drug was able to reduce the incidence of postprocedural pancreatitis to one half that of the control group. Unfortunately, the authors did provide any explanation for the discrepancy between positive results of the present study and negative data of a previous meta-analysis (2) and recent trials on this topic (3,4). Furthermore, they used a per-protocol analysis of their data, instead of the more appropriate intention-to-treat analysis. Indeed, they mention that of the 479 patients randomized to octreotide, 65 patients were excluded without providing reasons for such an action. Although this also happened in controls (482 patients randomized and 64 evaluated), one wonders how this exclusion might have affected the final results.