Efficacy of intramuscular diclofenac and fluid replacement in prevention of post-ERCP pancreatitis

Abstract

AIM:To assess the efficacy of intramuscular diclofenac and fluid replacement for prevention of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. METHODS:A prospective, placebo-controlled study was conducted in 80 patients who underwent ERCP. Patients were randomized to receive parenteral diclofenac at a loading dose of 75 mg followed by the infusion of 5-10 mL/kg per hour isotonic saline over 4 h after the procedure, or the infusion of 500 mL isotonic saline as placebo. Patients were evaluated clinically, and serum amylase levels were measured 4, 8 and 24 h after the procedure. RESULTS:The two groups were matched for age, sex, underlying disease, ERCP findings, and type of treatment. The overall incidence of pancreatitis was 7.5% in the diclofenac group and 17.5% in the placebo group (12.5% in total). There were no significant differences in the incidence of pancreatitis and other variables between the two groups. In the subgroup analysis, the frequency of pancreatitis in the patients without sphincter of Oddi dysfunction (SOD) was significantly lower in the diclofenac group than in the control group (P = 0.047).CONCLUSION: Intramuscular diclofenac and fluid replacement lowered the rate of pancreatitis in patients without SOD.

Contemporary Management of Acute Biliary Pancreatitis

“…Nonsteriod antiinflammary drugs (NSAIDs), on the other hand, may be used additionaly for pain management in cases where narcotics have weak effect or alone in cases with mild symptoms. Albeit, the use of NSAIDs have been reported to reduce the frequency of post-ERCP pancreatitis in patients without oddi sphincter dysfunction, due to antiinflammtory effect [54].…”

How and when should NSAIDs be used for preventing post-ERCP pancreatitis? A systematic review and meta-analysis

“…The rate of stent placement was similar in the NSAID and the placebo groups. Five studies reported that they did not use pancreatic stent for PEP prophylaxis [11,14,[16][17][18].…”

“…Nine studies, all published as full text articles, were included [10][11][12][13][14][15][16][17][18]. The characteristics and quality of the studies are shown in table 1.…”

“…The characteristics and quality of the studies are shown in table 1. Six studies were scored as high-quality (Jadad score 5) [10][11][12][13]15,18] and three as low-quality (Jadad score 2) [14,16,17].…”

“…The results of RCTs using nitroglycerine, ceftazidime, somatostatin, octreotide, antiprotease drugs, glucocorticoids, drugs reducing sphincter of Oddi pressure, antioxidant drugs, heparin, and Interleukin-10 have been disappointing [4]. Some studies have shown a benefit with NSAIDs [10][11][12][13][14][15][16][17][18], but a practice survey study performed some years ago showed that they were not widely used [19]. The main reason quoted was insufficient supporting evidence, but the authors speculate that clinicians' scepticism related to the failure of many other large studies with other pharmacological agents also played an important role.…”