Rectal diclofenac does not prevent post-ERCP pancreatitis in consecutive high-risk and low-risk patients

Abstract

Objective: rectal diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) that is used to prevent pancreatitis in high-risk patients during endoscopic retrograde cholangiopancreatography (ERCP). The European Society of Gastrointestinal Endoscopy (ESGE) recommends the use of prophylaxis with indomethacin or diclofenac in all patients undergoing ERCP, including those at low or intermediate risk of pancreatitis. A study to investigate the efficacy of this recommendation was performed.Methods: this was a mixed cohort study. A total of 1,512 ERCP procedures performed in our institution from January 2009 to July 2016 were included in the study. Until June 2012, 718 patients did not receive diclofenac. Subsequently, 794 patients without contraindications received 100 mg of rectal diclofenac at the onset of the procedure.Risk factors for post-ERCP pancreatitis (PEAP) and PEAP cases defined using consensus criteria were recorded.Results: a total of 47 PEAP events (3.1%) were reported, 3.4% in the diclofenac group and 2.8% in the non-diclofenac group (p = 0.554); 26.1% of patients had risk factors for PEAP. In the diclofenac group, PEAP developed in 4.4%, 0.5% and 2.6% of subjects with intact papillae, prior sphincterotomy and extended sphincterotomy, respectively. The results were similar for the non-diclofenac group: 4% with intact papillae, 0.9% with prior sphincterotomy, and 2.5% with extended sphincterotomy, respectively. PEAP severity was similar in both groups.Conclusions: rectal diclofenac before ERCP did not prevent the development of post-ERCP acute pancreatitis in non-selected consecutive patients.

Post-ERCP Complication Analysis of an Experienced Center

“…As noted by the European Society of Gastrointestinal Endoscopy,12 the completion of the procedure had a protective effect on PEP (OR 0.378 95% Cl 0.204 to 0.699). Some studies report that rectal indomethacin prevents PEP, whereas others state that rectal indomethacin does not affect PEP 34–37. In our study, no effect of rectal indomethacin use was found to prevent the development of PEP (p: 0.630).…”

“…Some studies report that rectal indomethacin prevents PEP, whereas others state that rectal indomethacin does not affect PEP. [34][35][36][37] In our study, no effect of rectal indomethacin use was found to prevent the development of PEP (p: 0.630).…”

Underutilization of prophylactic rectal indomethacin and pancreatic duct stent for prevention of post-ERCP Pancreatitis

“…All cases of rectal NSAIDs were accounted for by indomethacin. This is plausible as literature supporting the prophylactic efficacy of indomethacin is more robust compared to rectal diclofenac 8 16 17 25 26 27 . The mounting evidence in the literature supporting efficacy of indomethacin over diclofenac appears to have permeated into the practice patterns of advanced endoscopists performing ERCP.…”

Effects of Somatostatin and Indomethacin Mono or Combination Therapy on High-risk Hyperamylasemia and Post-pancreatitis Endoscopic Retrograde Cholangiopancreatography Patients: A Randomized Study

“…Recently, many scholars have researched the effects of indomethacin on preventing PEP, but the results are controversial. Some papers proved that indomethacin prevents PEP, 11 while others proved ineffective 12,13 . Somatostatin is a promising pharmacological agent because of its positive biological impacts, such as exocrine pancreatic secretion inhibition, reduction of the sphincter of Oddi contractions, modulation of the cytokine cascade, and protection against possible pancreatic acinar 14 .…”