Prophylaxis of pancreatitis with intravenous ketoprofen in a consecutive population of ERCP patients: a randomized double-blind placebo-controlled trial

Abstract

Background Acute pancreatitis is the most common complication after ERCP, occurring in about 4 % of the procedures. Only the placement of pancreatic duct prosthesis and the use of nonsteroidal anti-inflammatory drugs (NSAIDs) have shown benefit in the prevention of post-ERCP pancreatitis (PEP). Although the benefit of rectal administration of indomethacin or diclofenac is recommended by some studies and society guidelines especially in a selected group of high-risk patients, there is so far, no standardization of time or route of NSAID administration. The aim of the current study is to investigate the role of an intravenous NSAID administered before the procedure for PEP prevention. Methods In this randomized double-blind clinical trial, all consecutive patients who underwent ERCP were randomized to receive saline infusion with ketoprofen or saline, immediately before the procedure. Results A total of 477 patients were enrolled and completed follow-up. The majority of patients (72.1 %) had bile duct stones, and only 1.5 % had a clinical suspicion of sphincter of Oddi dysfunction. PEP developed in 5 of 253 (2 %) patients in the placebo group and in 5 of 224 (2.2 %) patients in the ketoprofen group (p = 1.). Conclusions Intravenous administration of ketoprofen immediately prior to ERCP did not result in reduction in PEP in a general population of ERCP patients.

Nonsteroidal anti-inflammatory drugs versus placebo for post-endoscopic retrograde cholangiopancreatography pancreatitis: a systematic review and meta-analysis

“…With regard to route of administration, NSAIDs were administered via the rectum, IV, IM, and per OS in 12, three, one, and twp studies, respectively. The following NSAIDs were used: diclofenac 17 18 19 20 21 22 23 24 25 26 27 28 , indomethacin 11 29 30 31 32 33 34 , naproxen 35 , valdecoxib 8 , and ketoprofen 36 . Study characteristics are outlined in Table 1 .…”

What is impact of nonsteroidal anti-inflammatory drugs in the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis: a meta-analysis of randomized controlled trials

“…Sample sizes ranged from 100 to 665, and the incidence rate of PEP varied from 2.24–16.43%. Diclofenac was used in eight studies [ 16 , 21 , 27 , 29 , 30 , 32 , 34 , 38 ], indomethacin in 9 studies [ 15 , 17 , 22 , 24 - 26 , 28 , 31 , 33 , 38 ], while valdecoxib [ 23 ], ketoprofen [ 37 ], naproxen [ 35 ], and celecoxib [ 36 ] were used in one study, respectively. NSAIDs were administered rectally in 14 studies [ 15 – 17 , 22 , 24 – 31 , 33 , 35 ], orally in two studies [ 36 , 38 ], intravenously in two studies [ 23 , 37 ], intramuscularly in two studies [ 21 , 32 ], and intramuscularly and rectally in one study [ 34 ].…”

“…Diclofenac was used in eight studies [ 16 , 21 , 27 , 29 , 30 , 32 , 34 , 38 ], indomethacin in 9 studies [ 15 , 17 , 22 , 24 - 26 , 28 , 31 , 33 , 38 ], while valdecoxib [ 23 ], ketoprofen [ 37 ], naproxen [ 35 ], and celecoxib [ 36 ] were used in one study, respectively. NSAIDs were administered rectally in 14 studies [ 15 – 17 , 22 , 24 – 31 , 33 , 35 ], orally in two studies [ 36 , 38 ], intravenously in two studies [ 23 , 37 ], intramuscularly in two studies [ 21 , 32 ], and intramuscularly and rectally in one study [ 34 ]. NSAIDs were administered pre-ERCP in 13 studies [ 17 , 21 , 23 , 24 , 26 , 28 , 30 , 31 , 33 – 38 ], post-ERCP in six studies [ 16 , 22 , 25 , 27 , 29 , 32 ], during ERCP in one study [ 15 ], and pre-ERCP combined with post-ERCP in one study [ 38 ].…”

“…There have been other research studies on the prevention of PEP administration of NSAIDs recently [ 23 , 36 , 37 ]. Most of the previous studies have confirmed the role of diclofenac and indomethacin in reducing the incidence of PEP.…”

Pharmacological Prevention of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis: Where Do We Stand Now?

“…Different postulated factors may act independently or aggregately to trigger PEP, but the end point of all these mechanisms is to activate inflammatory pathways. Targeting these pathways by preventive treatment options like drugs or addressing various technical issues in ERCP can be used to prevent PEP [6]. Even after improvements in techniques and expertise of endoscopists, the incidence of PEP is still high.…”