Background: Post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) is a common complication of therapeutic endoscopy. The aim of this trial was to determine whether a combination of rectal diclofenac and vigorous hydration with Ringer's lactate is superior to the corresponding individual treatments for preventing PEP in high-risk patients. Methods: This randomized, open-label, controlled trial was conducted from August 2020 to January 2022. We included patients who were at high risk of developing PEP. Three intervention groups were made: group A, diclofenac sodium suppository (100 mg); group B, aggressive hydration with Ringer's lactate; group C, a combination of diclofenac and aggressive hydration. PEP was defined as a serum amylase level > 3 times the upper limit of normal with epigastric pain within 24 hours after endoscopic retrograde cholangiopancreatography. Results: A total of 144 patients were included and 48 cases were randomized to each intervention group. The incidence of PEP was 8.3%, 10.4%, and 8.3% in groups A, B, and C, respectively. A personal history of alcohol consumption and more than one pancreatic duct guidewire cannulation were significantly associated with the development of PEP. Conclusion: No difference in the incidence of PEP was observed with or without the use of aggressive hydration. Combining aggressive hydration with a rectal nonsteroidal anti-inflammatory drug for preventing PEP cannot be recommended.
Introduction: About 50% of patients referred to tertiary care centre for constipation in the western countries have faecal evacuation disorder. A diagnosis of faecal evacuation disorder requires specialised investigations such as anorectal manometry. Anorectal manometry is a method to measure pressure exerted by the muscles in anus and rectum. Aim: To evaluate the characteristics of anorectal pressure in a cohort of western Indian patients with chronic constipation and faecal incontinence. Also, to evaluate the types of faecal evacuation disorders in patients with chronic constipation. Materials and Methods: The present retrospective study was conducted from January 2020 to May 2022 at Department of Gastroenterology, National Institute of Medical College and Research, Jaipur, Rajasthan. Total of 115 patients presented with chronic constipation and faecal incontinence, were included in the study. Sigmoidoscopy or full-length colonoscopy, Balloon Expulsion Test (BET) and anorectal manometry test were done in all the patients. Mean resting and squeeze pressure were measured by anorectal manometry. Continuous variables were summarised using means and standard deviations for normally distributed data. Statistical analysis was performed using Statistical Package for Social Sciences software (SPSS) version 20.0 (IBM Corp, Armonk, NY, USA). Results: Among 115, 62 were (53.9%) males and 53 (46.1%) females with mean age 51.9±16.2 years. In High Resolution Anorectal Manometry (HRAM), the mean resting anal pressure was 67.2±34.24 mmHg (range 14-183 mmHg) and mean squeeze pressure was 113.4±60.9 mmHg (range 30-290 mmHg). In present study type I dyssynergic defecations was most common with 20 (17.4%) patients. Conclusion: The present study showed that almost half of the patients had defecation disorders and type I dyssynergic defecations was most common, followed by type IV
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