Combination of diclofenac plus somatostatin in the prevention of post-ERCP pancreatitis: a randomized, double-blind, placebo-controlled trial

Katsinelos, Panagiotis; Fasoulas, Kostas; Paroutoglou, George; Chatzimavroudis, Grigoris; Beltsis, Athanasios; Terzoudis, Sotiris; Katsinelos, Taxiarchis; Dimou, Eleni; Zavos, Christos; Kaltsa, Agoritsa; Kountouras, Jannis

doi:10.1055/s-0031-1291440

Cited by 59 publications

(36 citation statements)

References 20 publications

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“…22 The PEP was defined by the Cotton 26 criteria in 5 trials, 19Y22,24 whereas, in 2 trials, PEP was defined as having a serum amylase level of more than 4 times the upper limit of the normal level along with abdominal pain. 23Y25 The severity of pancreatitis was assessed by the Cotton 26 criteria in 4 trials 19,21,22,24 and Ranson 27 criteria in 1 trial, 20 whereas 2 trials did not specify the definition of pancreatitis severity. 23,25 Meta-Analysis Results…”

Section: Outcome Assessmentmentioning

confidence: 99%

A Meta-Analysis on the Role of Rectal Diclofenac and Indomethacin in the Prevention of Post–Endoscopic Retrograde Cholangiopancreatography Pancreatitis

Sethi¹,

Sethi²,

Wadhwa³

et al. 2014

Pancreas

105

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Clinical trials evaluating the protective effect of nonsteroidal anti-inflammatory drugs (NSAIDs) for the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) have yielded inconclusive results. Our objective was to conduct a meta-analysis of the data to date to evaluate the efficacy and safety of rectal NSAIDs for PEP prophylaxis. We did a systematic search of PubMed/MEDLINE, Embase, and Web of Science databases and the Cochrane Central Register of Controlled Trials. The meta-analysis was performed using a fixed-effect method because of the absence of significant heterogeneity in the included trials. Seven randomized, controlled trials involving 2133 patients were included. The meta-analysis showed that rectal NSAIDs decreased the overall incidence of PEP (risk ratio, 0.44; 95% confidence interval, 0.34-0.57; P < 0.01). The number needed to treat was 11. The NSAID prophylaxis also decreased the incidence of moderate to severe PEP (risk ratio, 0.37; 95% confidence interval, 0.27-0.63; P < 0.01). The number needed to treat was 34. No differences of the adverse events attributable to NSAIDs were observed. In conclusion, prophylactic use of rectal NSAIDs reduces the incidence and severity of PEP. There is neither a difference in efficacy between rectal indomethacin and diclofenac nor a difference in efficacy between the timing of administration of rectal NSAIDs, that is, immediate pre-ERCP and post-ERCP.

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Section: Outcome Assessmentmentioning

confidence: 99%

A Meta-Analysis on the Role of Rectal Diclofenac and Indomethacin in the Prevention of Post–Endoscopic Retrograde Cholangiopancreatography Pancreatitis

Sethi¹,

Sethi²,

Wadhwa³

et al. 2014

Pancreas

105

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“…23 Another study was excluded because the somatostatin was also used in the NSAIDs group. 24 In the end, a total of 10 RCTs were included. [8][9][10][11][12][13]22,[25][26][27] Basic characteristics of the included RCTs are shown in Table 1.…”

Section: Take-home Messagementioning

confidence: 99%

Nonsteroidal anti-inflammatory drugs for prevention of post-ERCP pancreatitis: a meta-analysis

Ding

Chen

Huang

et al. 2012

Gastrointestinal Endoscopy

108

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“…The majority (80%-90%) of simple CBD stones, specifically those that are < 1 cm, are removed by ERC via endoscopic sphincterotomy by using a basket or balloon catheter [2,3] . However, from references [4][5][6][7][8][9][10][11][12][13][14][15] , we know that approximately 10%-15% of patients have bile duct stones that cannot be removed using standard techniques. These stones are generally larger than 1-1.5 cm, impacted, located proximal to strictures, or associated with the duodenal diverticulum, and are frequently successfully removed by mechanical lithotripsy or large balloon sphincteroplasty [16] .…”

Section: Introductionmentioning

confidence: 99%

Failure of sequential biliary stenting for unsuccessful common bile duct stone removal

Prachayakul

Aswakul²

2013

WJGE

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AIM:To determine the factors associated with the failure of stone removal by a biliary stenting strategy. METHODS:We retrospectively reviewed 645 patients with common bile duct (CBD) stones who underwent endoscopic retrograde cholangiography for stone removal in Siriraj GI Endoscopy center, Siriraj Hospital from June 2009 to June 2012. A total of 42 patients with unsuccessful initial removal of large CBD stones that underwent sequential biliary stenting were enrolled in the present study. The demographic data, laboratory results, stone characteristics, procedure details, and clinical outcomes were recorded and analyzed. In addition, the patients were classified into two groups based on outcome, successful or failed sequential biliary stenting, and the above factors were compared. RESULTS:Among the initial 42 patients with unsuccessful initial removal of large CBD stones, there were 37 successful biliary stenting cases and five failed cases. Complete CBD clearance was achieved in 88.0% of cases. The average number of sessions needed before complete stone removal was achieved was 2.43 at an average of 25 wk after the first procedure. Complications during the follow-up period occurred in 19.1% of cases, comprising ascending cholangitis (14.3%) and pancreatitis (4.8%). The factors associated with failure of complete CBD stone clearance in the biliary stenting group were unchanged CBD stone size after the first biliary stenting attempt (10.2 wk) and a greater number of endoscopic retrograde cholangio-pancreatography sessions performed (4.2 sessions). CONCLUSION:The sequential biliary stenting is an effective management strategy for the failure of initial large CBD stone removal. Key words: Endoscopic retrograde cholangiography; Common bile duct stone; Biliary stenting; Large common bile duct stone; Biliary stenting failure Core tip: This study was a retrospective review of 42 patients who underwent sequential biliary stenting following a failed removal of a large common bile duct stone by endoscopic retrograde cholangiopancreatography. Complete common bile duct (CBD) clearance was achieved in 88% of the patients at 25 wk after the first procedure, while 19% reported complications. The common complications were cholangitis and pancreatitis. The factors associated with the failure of this strategy were unchanged CBD stone size at the second biliary stenting attempt, and more endoscopic retrograde cholangio-pancreatography sessions performed.Prachayakul V, Aswakul P. Failure of sequential biliary stenting for unsuccessful common bile duct stone removal. World J Gastrointest Endosc 2013; 5(6): 288-292 Available from: URL:

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Combination of diclofenac plus somatostatin in the prevention of post-ERCP pancreatitis: a randomized, double-blind, placebo-controlled trial

Abstract: Although combined prophylactic therapy with diclofenac plus somatostatin was promising in reducing frequency of PEP, further comparative large-scale studies are needed to confirm our findings before definitive conclusions can be drawn.

Cited by 59 publications

References 20 publications

A Meta-Analysis on the Role of Rectal Diclofenac and Indomethacin in the Prevention of Post–Endoscopic Retrograde Cholangiopancreatography Pancreatitis

A Meta-Analysis on the Role of Rectal Diclofenac and Indomethacin in the Prevention of Post–Endoscopic Retrograde Cholangiopancreatography Pancreatitis

Nonsteroidal anti-inflammatory drugs for prevention of post-ERCP pancreatitis: a meta-analysis

Failure of sequential biliary stenting for unsuccessful common bile duct stone removal

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