Low-dose rectal diclofenac for prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis: a randomized controlled trial

Abstract

Low-dose rectal diclofenac can prevent PEP.

Endoscopic retrograde cholangiopancreatography complications: Techniques to reduce risk and management strategies

“…However the PEP rates for placebo controls (10%-20%) were higher than should be expected. [129][130][131] For comparison purposes, a PRCT concluding that neither somatostatin or gabexate was better than placebo in average-risk patients reported that the overall incidence of PEP was 5.6%. 32 Another PRCT in average-risk patients reported a nonsignificant trend in favor of rectal indomethacin (given before ERCP) for protection of PEP (3% vs 7%).…”

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

“…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 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].…”

“…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.…”