Role of vitamin C and rectal indomethacin in preventing and alleviating post-endoscopic retrograde cholangiopancreatography pancreatitis: a clinical study.
Amylases
Endoscopic retrograde cholangiopancreatography
Lipase
Pancreatitis
Vitamin C
Journal
Clinical endoscopy
ISSN: 2234-2400
Titre abrégé: Clin Endosc
Pays: Korea (South)
ID NLM: 101576886
Informations de publication
Date de publication:
Mar 2023
Mar 2023
Historique:
received:
05
06
2022
accepted:
27
06
2022
medline:
5
4
2023
entrez:
4
4
2023
pubmed:
5
4
2023
Statut:
ppublish
Résumé
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. 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. 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 and per-protocol analyses (p=0.034 and p=0.031, respectively). The post-ERCP lipase and amylase concentrations were lower in the combination arm than in the indomethacin alone arm (p=0.034 and p=0.029, respectively). Vitamin C injection in addition to rectal indomethacin reduced PEP occurrence and severity.
Sections du résumé
BACKGROUND/AIMS
OBJECTIVE
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
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
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 and per-protocol analyses (p=0.034 and p=0.031, respectively). The post-ERCP lipase and amylase concentrations were lower in the combination arm than in the indomethacin alone arm (p=0.034 and p=0.029, respectively).
CONCLUSION
CONCLUSIONS
Vitamin C injection in addition to rectal indomethacin reduced PEP occurrence and severity.
Identifiants
pubmed: 37013392
pii: ce.2022.165
doi: 10.5946/ce.2022.165
pmc: PMC10073861
doi:
Types de publication
Journal Article
Langues
eng
Pagination
214-220Références
Free Radic Res. 2013 Nov;47(11):917-33
pubmed: 23952531
J Gastrointestin Liver Dis. 2020 Sep 09;29(3):445-454
pubmed: 32919425
Br J Surg. 1993 Jun;80(6):750-4
pubmed: 8330166
Curr Gastroenterol Rep. 2020 Nov 13;22(12):59
pubmed: 33188441
Dig Dis Sci. 2020 Feb;65(2):361-375
pubmed: 31792671
Turk J Gastroenterol. 2013;24(6):469-75
pubmed: 24623284
J Gastrointest Surg. 2001 Jul-Aug;5(4):339-45; discussion 345
pubmed: 11985972
World J Gastroenterol. 2015 Aug 14;21(30):9189-208
pubmed: 26290647
Gastrointest Endosc. 2011 May;73(5):868-74
pubmed: 21377673
Gut. 2013 Jan;62(1):102-11
pubmed: 23100216
Gastrointest Endosc. 2005 Jul;62(1):105-11
pubmed: 15990827
World J Gastroenterol. 2009 Sep 28;15(36):4481-90
pubmed: 19777606
Acta Med Iran. 2011;49(9):579-83
pubmed: 22052140
Gut. 2007 Oct;56(10):1439-44
pubmed: 17356040
Endoscopy. 2020 Feb;52(2):127-149
pubmed: 31863440
Free Radic Res. 2005 Jul;39(7):671-86
pubmed: 16036346
Eur J Gastroenterol Hepatol. 2017 Mar;29(3):349-354
pubmed: 27849643
Acta Gastroenterol Belg. 2020 Oct-Dec;83(4):598-602
pubmed: 33321017
Br J Surg. 1999 Oct;86(10):1296-301
pubmed: 10540137
Clin Exp Gastroenterol. 2021 Feb 02;14:27-32
pubmed: 33564256
Case Rep Gastroenterol. 2018 Apr 13;12(1):125-136
pubmed: 29805355
Pancreatology. 2017 Jul - Aug;17(4):529-533
pubmed: 28687456