Rectal NSAIDs for the prevention of post-ERCP pancreatitis: A meta-analysis of randomized controlled trials

Sun, Han; Han, Bing; Zhai, Hong-Peng; Cheng, Xiaojuan; Ma, Kai

doi:10.1016/j.surge.2013.10.010

Cited by 70 publications

(45 citation statements)

References 18 publications

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“…NSAIDs were seen to be beneficial for PEAP prevention in randomized, controlled studies, as well as in several meta-analyses (11,12,16,17). Such results led the European Society of Gastrointestinal Endoscopy (ESGE) to recommend the use of indomethacin or diclofenac either before or after ERCP procedures from 2010 in their guidelines (18,19).…”

Section: Discussionmentioning

confidence: 99%

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

2018

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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.

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Section: Discussionmentioning

confidence: 99%

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

2018

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“…In fact, the rates of PEP in symptomatic patients treated with the analgesics were similar. We gave ketorolac with a primary analgesic purpose but we also wanted to retrospectively analyze its prophylactic properties on PEP since some NSAIDs, such as indomethacin and diclofenac, have proved effective in reducing this complication in an increasing number of studies [7][8][9][10][11]. This was particularly observed in patients at high-risk of PEP in which high "intrinsic pancreatic parenchyma hypersensitivity" or papillary edema and consequent temporary pancreatic ductal obstruction induced by repeated cannulation attempts are considered pathophysiological mechanisms of PEP.…”

Section: Discussionmentioning

confidence: 99%

“…An Open Access Publisher indomethacin to be effective for the prevention of PEP [7][8][9][10][11][12]. Based on these data recent European guidelines recommend the routine rectal administration of 100 mg of diclofenac or indomethacin in all patients, if there are no contraindications, immediately before or after ERCP to reduce the risk of PEP [8].…”

Section: Open Accessmentioning

confidence: 99%

The incidence of post-ERCP pancreatitis is not reduced in patients given intravenous ketorolac for post-procedural abdominal pain

Mariani¹,

Ml²,

Léo³

et al. 2016

J Hepatol Gastroenterol.

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“…[120][121][122][123][124][125][126][127] Validity of these conclusions could be questioned however, due to some findings which was difficult to explain or discordant to each other. 128 Several of the early PRCT reported that RNSAID (diclofenac) significantly reduced PEP in average-risk patients.…”

Section: Post-ercp Prophylaxismentioning

confidence: 99%

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

Tarnasky

Kedia

2017

Int J Gastrointest Interv

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Adverse events after endoscopic retrograde cholangiopancreatography (ERCP) are not uncommon and can be associated with tragic outcomes. Bleeding, perforation, and post-ERCP pancreatitis are the most common complications. Some events are unavoidable; others are associated with well described risk factors so that they can be either anticipated and/or measures can be taken for prevention or at least risk reduction. This review will focus on the more common complications after ERCP, their risk factors, and potential strategies for risk reduction. Additionally, recommendations for management of ERCP complications will be presented.

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Rectal NSAIDs for the prevention of post-ERCP pancreatitis: A meta-analysis of randomized controlled trials

Cited by 70 publications

References 18 publications

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

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

The incidence of post-ERCP pancreatitis is not reduced in patients given intravenous ketorolac for post-procedural abdominal pain

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

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