Gastroenterology

Gastroenterology

Volume 124, Issue 7, June 2003, Pages 1786-1791
Gastroenterology

Clinical-liver, pancreas, and biliary tract
Diclofenac reduces the incidence of acute pancreatitis after endoscopic retrograde cholangiopancreatography

The data from this study after 200 patients had been entered was presented to the American Pancreatic Association in November 2001 and to the Association of Surgeons of Great Britain and Ireland on May 23, 2002.
https://doi.org/10.1016/S0016-5085(03)00384-6Get rights and content

Abstract

Background & Aims:

Acute pancreatitis following endoscopic retrograde cholangiopancreatography presents a unique opportunity for prophylaxis and early modification of the disease process because the initial triggering event is temporally well defined and takes place in the hospital. We report a prospective, single-center, randomized, double-blind controlled trial to determine if rectal diclofenac reduces the incidence of pancreatitis following cholangiopancreatography.

Methods:

Entry to the trial was restricted to patients who underwent endoscopic retrograde pancreatography or had manometrically verified sphincter of Oddi hypertension. Immediately after endoscopy, patients were given a suppository containing either 100 mg diclofenac or placebo. Estimation of serum amylase levels and clinical evaluation were performed in all patients.

Results:

A total of 220 patients entered the trial, and 110 received rectal diclofenac. Twenty-four patients developed pancreatitis (11%), of whom 7 received rectal diclofenac and 17 received placebo (P < 0.05).

Conclusions:

This trial shows that rectal diclofenac given immediately after endoscopic retrograde cholangiopancreatography can reduce the incidence of acute pancreatitis.

Section snippets

Patients and methods

The study described in this report was approved by the ethics committee of Glasgow Royal Infirmary University National Health Service Hospitals Trust. Adult patients without clinical or biochemical evidence of acute or severe chronic pancreatitis due to undergo ERCP under the care of 3 experienced endoscopists (B.M., R.C., and C.I.) were asked to give informed consent to participate in the study. Patients were excluded if they had any contraindications to receiving diclofenac or had taken an

Results

A total of 220 patients entered the study; 110 received 100 mg diclofenac per rectum (diclofenac group), and 110 received an inert suppository (control group). There were 69 women in the diclofenac group and 74 women in the control group. The patients were well matched in regard to age (mean ± SDM; diclofenac group, 55 ± 15 years; control group, 58 ± 14 years). Table 1, Table 2 show that the 2 groups were well matched for diagnoses, procedures performed, and factors that might increase the

Discussion

We have shown that a single inexpensive 100-mg diclofenac suppository given immediately after ERCP can reduce the incidence of post-ERCP pancreatitis. The incidence of acute pancreatitis after ERCP varies according to the indications for the procedure, patient characteristics, and type of intervention performed. It is perhaps optimistically reported as 1%–2% for diagnostic ERCP, 1%–4% for endoscopic sphincterotomy, 4%–8% for pancreatic sphincterotomy, and 8%–11% for sphincterotomies in patients

References (36)

  • T. Rabenstein et al.

    Complications of endoscopic sphincterotomycan heparin prevent acute pancreatitis after ERCP?

    Gastrointest Endosc

    (2002)
  • P.R. Tarnasky et al.

    Pancreatic stenting prevents pancreatitis after biliary sphincterotomy in patients with sphincter of Oddi dysfunction

    Gastroenterology

    (1998)
  • F. Diaz-Gonzalez et al.

    Inhibition of leukocyte adhesionan alternative mechanism of action for the anti-inflammatory drugs

    Immunol Today

    (1998)
  • G. LaFerla et al.

    Hyperamylasaemia and acute pancreatitis following retrograde cholangiography

    Pancreas

    (1985)
  • T. Rabenstein et al.

    Post-ERCP pancreatitisnew momentum

    Endoscopy

    (2002)
  • D. Vaira et al.

    Endoscopic sphincterotomy in 1000 consecutive patients

    Lancet

    (1989)
  • M.L. Freeman et al.

    Risk factors for post-ERCP pancreatitisa prospective, multicenter study

    Gastrointest Endosc

    (2001)
  • M. Barthet et al.

    Complications of endoscopic sphincterotomyresults from a tertiary referral center

    Endoscopy

    (2002)
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