Rectal versus intramuscular diclofenac in prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis: experience of a Greek tertiary referral center.
endoscopic retrograde cholangiopancreatography
non-steroidal anti-inflammatory drugs
post-ERCP pancreatitis
Journal
Annals of gastroenterology
ISSN: 1108-7471
Titre abrégé: Ann Gastroenterol
Pays: Greece
ID NLM: 101121847
Informations de publication
Date de publication:
Historique:
received:
05
08
2019
accepted:
15
11
2019
entrez:
7
7
2020
pubmed:
7
7
2020
medline:
7
7
2020
Statut:
ppublish
Résumé
Independent patient-related and procedure-related factors increase the risk of pancreatitis after endoscopic retrograde cholangiopancreatography (post-ERCP pancreatitis [PEP]). Non-steroidal anti-inflammatory drugs (NSAIDs) have demonstrated efficacy in reducing the incidence of PEP. This study investigated the difference in the incidence of PEP between intramuscular and rectal prophylactic administration of diclofenac before ERCP. We performed a retrospective analysis of data from 516 patients who underwent ERCP during the period 2014-2017. The route of diclofenac administration (rectal or intramuscular), patient-related and procedure-related risk factors, as well as serum amylase levels 18 h after the endoscopic procedure and immediate bleeding during ERCP were recorded and evaluated. The overall incidence of PEP was 4.5%, without significant differences between the rectal (5.2%) and intramuscular (3.9%) routes of administration. The factor that appeared to be of significance was pre-cut sphincterotomy, since patients who underwent that procedure showed a higher probability of PEP (P=0.05; odds ratio 2.67, 95% confidence interval). Intraprocedural bleeding was almost twice as frequent in the rectal compared to the intramuscular group. Pancreatic stent placement did not appear to be statistically significant in the prevention of PEP, either alone or in combination with diclofenac administration. The results of our study did not reveal any statistically significant difference between the rectal or intramuscular administration of diclofenac in the prevention of PEP, contradicting the results of the majority of studies and meta-analyses published so far. One of the known risk factors associated with increased risk of PEP was also confirmed.
Sections du résumé
BACKGROUND
BACKGROUND
Independent patient-related and procedure-related factors increase the risk of pancreatitis after endoscopic retrograde cholangiopancreatography (post-ERCP pancreatitis [PEP]). Non-steroidal anti-inflammatory drugs (NSAIDs) have demonstrated efficacy in reducing the incidence of PEP. This study investigated the difference in the incidence of PEP between intramuscular and rectal prophylactic administration of diclofenac before ERCP.
METHODS
METHODS
We performed a retrospective analysis of data from 516 patients who underwent ERCP during the period 2014-2017. The route of diclofenac administration (rectal or intramuscular), patient-related and procedure-related risk factors, as well as serum amylase levels 18 h after the endoscopic procedure and immediate bleeding during ERCP were recorded and evaluated.
RESULTS
RESULTS
The overall incidence of PEP was 4.5%, without significant differences between the rectal (5.2%) and intramuscular (3.9%) routes of administration. The factor that appeared to be of significance was pre-cut sphincterotomy, since patients who underwent that procedure showed a higher probability of PEP (P=0.05; odds ratio 2.67, 95% confidence interval). Intraprocedural bleeding was almost twice as frequent in the rectal compared to the intramuscular group. Pancreatic stent placement did not appear to be statistically significant in the prevention of PEP, either alone or in combination with diclofenac administration.
CONCLUSIONS
CONCLUSIONS
The results of our study did not reveal any statistically significant difference between the rectal or intramuscular administration of diclofenac in the prevention of PEP, contradicting the results of the majority of studies and meta-analyses published so far. One of the known risk factors associated with increased risk of PEP was also confirmed.
Identifiants
pubmed: 32624663
doi: 10.20524/aog.2020.0487
pii: AnnGastroenterol-33-412
pmc: PMC7315719
doi:
Types de publication
Journal Article
Langues
eng
Pagination
412-417Informations de copyright
Copyright: © Hellenic Society of Gastroenterology.
Déclaration de conflit d'intérêts
Conflict of Interest: None
Références
Clin Gastroenterol Hepatol. 2013 Jul;11(7):778-83
pubmed: 23376320
Gut. 2013 Jan;62(1):102-11
pubmed: 23100216
Gastrointest Endosc. 2017 Jun;85(6):1144-1156.e1
pubmed: 28167118
J Clin Gastroenterol. 2017 Sep;51(8):e68-e76
pubmed: 28609383
Turk J Med Sci. 2016 Jun 23;46(4):1059-63
pubmed: 27513404
Gut. 2008 Sep;57(9):1262-7
pubmed: 18375470
Endoscopy. 2007 Sep;39(9):793-801
pubmed: 17703388
World J Gastrointest Pathophysiol. 2014 Feb 15;5(1):1-10
pubmed: 24891970
World J Gastroenterol. 2014 Sep 14;20(34):12322-9
pubmed: 25232268
Dig Dis Sci. 2014 Dec;59(12):2992-6
pubmed: 25030943
Pancreas. 2015 Aug;44(6):859-67
pubmed: 26168316
Gastrointest Endosc. 2009 Jul;70(1):80-8
pubmed: 19286178
PLoS One. 2014 Mar 27;9(3):e92922
pubmed: 24675922
Gastrointest Endosc. 2012 Dec;76(6):1152-9
pubmed: 23164513
N Engl J Med. 2012 Apr 12;366(15):1414-22
pubmed: 22494121
Endoscopy. 2016 Jul;48(7):657-83
pubmed: 27299638
Gastrointest Endosc. 2012 Mar;75(3):467-73
pubmed: 22341094
World J Gastroenterol. 2009 Aug 28;15(32):3999-4004
pubmed: 19705494
Endoscopy. 2014 Sep;46(9):799-815
pubmed: 25148137
Hepatobiliary Pancreat Dis Int. 2009 Feb;8(1):11-6
pubmed: 19208508