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    • Berner et al used a meta analysis to

    2020-11-26

    Berner et al used a meta-analysis to show that sildenafil resulted in an effect of 9.65-point improvement. Tadalafil could be pooled into an effect of 8.52-point improvement, and vardenafil showed an effect of 7.50-point improvement. In our present studies, 200 mg udenafil resulted in an effect of 8.62-point improvement, consistent with the study by Berner et al. Giuliano et al reported that the incidence of ED was approximately 61% in patients with hypertension. During the past 20 years, the relationship between ED and G007-LK has increasingly become important owing to the increase in the number of patients with hypertension. For hypertensive patients with ED, a previous meta-analysis of 2427 patients demonstrated that vardenafil showed an average increase of 8.9 points in the IIEF-EF at week 12 compared with placebo. Our pooled results showed that udenafil resulted in an average increase of 5.58-point improvement. In the Massachusetts Male Aging Study, a landmark community-based survey of predominantly white men aged 40-69 years, the age-adjusted risk of developing ED for treated or untreated self-reported diabetic patients was 1.83 and was statistically significant.25, 26 Approximately 50% of diabetic men develop ED at least once in the course of their disease. For the IIEF ED domain, Vardi and Nini reported that sildenafil resulted in an effect of 7.83-point improvement. Tadalafil could be pooled into an effect of 3.39-point improvement, and vardenafil showed an effect of 3.93-point improvement. Our study indicated that udenafil resulted in an effect of 4.06-point improvement. In the present meta-analysis, the most common drug-related adverse events were flushing and headache. A recent meta-analysis demonstrated that in short-term trials (<6 months), sildenafil-treated men had a greater risk of headache, flushing, dyspepsia, and visual disturbances compared with placebo-treated men. This indicated that udenafil is comparable to sildenafil in drug-related adverse events. Our meta-analysis also had several limitations. First, all included studies were of moderate quality in this meta-analysis. This might not allow a reliable conclusion. Second, all participants came from Korea. Thus, more studies are needed from other countries and of other races to evaluate the effectiveness of udenafil. Third, the dose of udenafil ranged from 25 to 200 mg, and the optimal dose needs to explored further. Fourth, we lacked the data to perform subgroup analysis according to the duration and severity of ED.
    Conclusions
    Pancreatitis is the most common complication of ERCP. Its frequency in recent prospective studies ranged from 5% to 20%., , , , , , , , , , Post-ERCP pancreatitis is generally mild but can be fatal in some cases. All efforts to minimize the development of post-ERCP pancreatitis have been continued in several ways, and the following strategies for prevention of post-ERCP pancreatitis have been proposed: strict patient selection, proper application of endoscopic technical maneuvers including placement of pancreatic stents,, wire-guided cannulation, minimizing pancreatic injection,, and administration of prophylactic drugs., , , , , , , , Pharmacological prevention of post-ERCP pancreatitis has focused on the interruption of several postulated mechanisms of injury: (1) relaxation of sphincter of Oddi (SO) and consequent promotion of pancreatic drainage by calcium channel antagonists and nitroglycerin, , ; (2) interruption of the inflammatory cascade by gabexate, nafamostat, and nonsteroidal anti-inflammatory drugs (NSAIDs), ; and (3) inhibition of pancreatic secretion by somatostatin and octreotide. Clinical studies of pharmacological prevention have reported conflicting results. Only NSAIDs administered rectally were effective in preventing post-ERCP pancreatitis. Phosphodiesterase type 5 (PDE-5) inhibitor is a smooth-muscle relaxant. Beyond its original indication for erectile dysfunction and other vascular diseases including pulmonary artery hypertension and Raynaud's phenomenon, clinical investigation has been expanded to hypercontractile esophageal motility disorders and biliary SO dysfunction (SOD). PDE-5 inhibitors reduced basal SO pressure. Administration of a PDE-5 inhibitor before ERCP may decrease SO tone, allow easy cannulation, and ultimately reduce the occurrence of post-ERCP pancreatitis. The aim of this study was to determine whether prophylactic PDE-5 inhibitor administration reduces the rates of occurrence of post-ERCP pancreatitis.