Role of vitamin C and rectal indomethacin in preventing and alleviating post-endoscopic retrograde cholangiopancreatography pancreatitis: a clinical study

Abstract

Background/Aims: This study aimed to determine whether vitamin C in addition to indomethacin decreases the occurrence and severity of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) occurrence and severity. Methods: This randomized clinical trial included patients undergoing ERCP. The participants were administered either rectal indomethacin (100 mg) plus an injection of vitamin C (500 mg) or rectal indomethacin (100 mg) alone just before ERCP. The primary outcomes were PEP occurrence and severity. The secondary amylase and lipase levels were determined after 24 hours. Results: A total of 344 patients completed the study. Based on intention-to-treat analysis, the PEP rates were 9.9% for indomethacin plus vitamin C plus indomethacin and 15.7% for indomethacin alone. Regarding the per-protocol analysis, the PEP rates were 9.7% and 15.7% in the combination and indomethacin arms, respectively. There was a remarkable difference between the two arms in PEP occurrence and severity on intention-to-treat or per-protocol analysis (p=0.034 and p=0.031, respectively). The secondary lipase and amylase concentrations were lower in the combination arm than in the indomethacin alone arm (p=0.034 and p=0.029, respectively). Conclusions: Vitamin C injection in addition to rectal indomethacin reduced PEP occurrence and severity

Effect of CoQ10 Addition to Rectal Indomethacin on Clinical Pancreatitis and Related Biomarkers in Post-endoscopic Retrograde Cholangiopancreatography

“…Post-ERCP pancreatitis is a complication whose exact mechanism has not been determined. Damage to the pancreatic acinar cells starts a complex flood of events that contains (19). Regarding the efficacy of CoQ10 in the alleviation of oxidative stress, we designed the present trial to determine the efficacy and safety of the addition of CoQ10 vs placebo to the rectal indomethacin in the PEP occurrence and severity.…”

Double-guidewire technique for selective biliary cannulation does not increase the rate of post-endoscopic retrograde cholangiopancreatography pancreatitis in patients with naïve papilla

“…PEP is one of the most common and severe complications of ERCP. [12][13][14] The incidence of PEP ranges from 0.4% to 1.5% in diagnostic ERCP and 1.6% to 5.4% in therapeutic ERCP. 15 It is often clinically mild or moderate in severity; however, in approximately 10% of cases, it is severe and potentially fatal.…”