Hemin to Prevent Post-ERCP (Endoscopic Retrograde Cholangiopancreatography) Acute Pancreatitis
Hemin to Prevent Post-ERCP (Endoscopic Retrograde Cholangiopancreatography) Acute Pancreatitis
ERCP (endoscopic retrograde cholangiopancreatography) has been largely demonstrated to be
 effective in multiple bilio-pancreatic indications. However, one of the feared complication
 of this technique is acute pancreatitis, which happens in 5 to 25% of cases. Some patient
 groups have been demonstrated to present a higher risk linked to individual factors or to the
 procedure. Some interventions (endoscopic or pharmacologic) have been evaluated to reduce the
 incidence of this complication but each has his own inconvenient. Recently, the activation of
 heme oxygenase (HO) by intraperitoneal administration of hemin has been demonstrated to be
 effective in prevention and treatment of acute pancreatitis mice models. This protective
 effect has been associated to intrapancreatic HO-1 positive macrophage recruitment activated
 by hemin. The investigators thus propose to conduct a prospective randomized double blind
 controlled trial to demonstrate a protective effect of hemin administration against post-ERCP
 acute pancreatitis in high risk patients.
Patients for who a pancreatic stent placement is indicated will be excluded from the study.

 The aims of this study are: 1) to study in a pathophysiologic point of view the activation of
 HO-1 by hemin in human and its protective effect in post-ERCP acute pancreatitis incidence.
 2) to use the human situation of post-ERCP acute pancreatitis as early pancreatitis model to
 study the administration of hemin as treatment of acute pancreatitis in general.
Inclusion Criteria: one or more factors of >10% post-ERCP acute pancreatitis risk:

 -  former episode of acute pancreatitis

 -  former episode of post-ERCP acute pancreatitis

 -  normal bilirubin level

 -  main pancreatic duct injection

 -  endoscopic biliary sphincteroplasty (balloon dilation of biliary sphincter)

 -  precut papillotomy

 -  pancreatic sphincterotomy

 Exclusion Criteria:

 -  patient for whom a pancreatic stent is inserted (Sphincter of Oddi dysfunction,
 ampullectomy)

 -  ongoing acute pancreatitis

 -  chronic pancreatitis (Cremer classification >=2)

 -  age < 18 y/o

 -  pregnancy

 -  hemin allergy

 -  severe renal failure (MDRD<30ml/min/1.73m2)