A Randomized Trial of Rectal Indomethacin and Sublingual Nitrates to Prevent Post-ERCP Pancreatitis

Sotoudehmanesh, Rasoul; Eloubeidi, Mohamad A.; Asgari, Ali; Farsinejad, Maryam; Khatibian, Morteza

doi:10.1038/ajg.2014.9

Cited by 64 publications

(47 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…[78][79][80][81] Recently, however, Sotoudehmanesh et al evaluated combination therapy with rectal indomethacin and sublingual nitrates in the prevention of PEP, with patients at high risk for PEP in mind (>80%). 82 In this double-blind RCT, 300 patients were randomized to receive 100 mg of rectal indomethacin plus 5 mg of sublingual nitrate, or 100 mg of rectal indomethacin plus sublingual placebo before ERCP. They found the rates of PEP to be significantly decreased in patients who received combination indomethacinnitroglycerin therapy compared with the indomethacin-placebo cohort (6.7% vs 15.3%, respectively; P¼.02).…”

Section: Nitroglycerinmentioning

confidence: 99%

The “Scope” of Post-ERCP Pancreatitis

Parekh

Majithia

Sikka

et al. 2017

Mayo Clinic Proceedings

View full text Add to dashboard Cite

Pancreatitis is the most common adverse event of endoscopic retrograde cholangiopancreatography, with the potential for clinically significant morbidity and mortality. Several patient and procedural risk factors have been identified that increase the risk of post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP). Considerable research efforts have identified several pharmacologic and procedural interventions that can drastically affect the incidence of PEP. This review article addresses the underlying mechanisms at play for the development of PEP, identifying patient and procedural risk factors and meaningful use of risk-stratification information, and details current interventions aimed at reducing the risk of this complication.

show abstract

Section: Nitroglycerinmentioning

confidence: 99%

The “Scope” of Post-ERCP Pancreatitis

Parekh

Majithia

Sikka

et al. 2017

Mayo Clinic Proceedings

View full text Add to dashboard Cite

show abstract

“…The most recent meta-analysis included 11 randomized placebo-controlled studies and found a significant decrease for overall post-ERCP pancreatitis in patients receiving nitrates, but no reduction in moderate- and high-severity pancreatitis [ 40 ]; however, only 3 of the 11 studies in this analysis showed a significant difference between the nitrate and placebo, and some of the studies had an unusually high background rate of pancreatitis for average risk patients, thereby limiting conclusions about high-risk patients [ 1 ]. Another double-blinded, randomized, controlled trial published in 2014 compared rectal indomethacin plus sublingual nitrate against rectal indomethacin and placebo prior to ERCP for 300 patients at a single center [ 41 ]. This study found a significant reduction in the incidence of post-ERCP pancreatitis for a combination of the nitrate with indomethacin than for indomethacin alone.…”

Section: Preventive Strategiesmentioning

confidence: 99%

Post-endoscopic retrograde cholangiopancreatography pancreatitis

Thaker

Mosko

Berzin

2014

Gastroenterology Report

View full text Add to dashboard Cite

Acute pancreatitis remains the most common complication of endoscopic retrograde cholangiopancreatography (ERCP). It is reported to occur in 2–10% of unselected patient samples and up to 40% of high-risk patients. The purpose of this article is to review the evidence behind the known risk factors for post-ERCP pancreatitis, as well as the technical and medical approaches developed to prevent it. There have been many advances in identifying the causes of this condition. Based on this knowledge, a variety of preventive strategies have been developed and studied. The approach to prevention begins with careful patient selection and performing ERCP for specific indications, while considering alternative diagnostic modalities when appropriate. Patients should also be classified by high-risk factors such as young age, female sex, suspected sphincter of Oddi dysfunction, a history of post-ERCP pancreatitis, and normal serum bilirubin, all of which have been identified in numerous research studies. The pathways of injury that are believed to cause post-ERCP pancreatitis eventually lead to the common endpoint of inflammation, and these individual steps can be targeted for preventive therapies through procedural techniques and medical management. This includes the use of a guide wire for cannulation, minimizing the number of cannulation attempts, avoiding contrast injections or trauma to the pancreatic duct, and placement of a temporary pancreatic duct stent in high-risk patients. Administration of rectal non-steroidal anti-inflammatory agents (NSAIDs) in high-risk patients is the proven pharmacological measure for prevention of post-ERCP pancreatitis. The evidence for or against numerous other attempted therapies is still unclear, and ongoing investigation is required.

show abstract

“…The overall risk of PEP in these studies has been rather high (6.9-26%) due to their patient selection. [18][19][20][21][22][23][24][25][26] The American Society for Gastrointestinal endoscopy (ASGE) recommends rectal indomethacine for the prevention of PEP in average-risk individuals. 27 In Asia, Japanese guidelines recommend administration of intrarectal NSAIDS for all cases undergoing ERCP with no contraindications.…”

Section: Introductionmentioning

confidence: 99%