Effect of rectal indomethacin for preventing post-ERCP pancreatitis depends on difficulties of cannulation: results from a randomized study with sequential biliary intubation

Journal of Clinical Gastroenterology
Árpád PataiÁrpád V Patai

Abstract

The greatest challenges for endoscopists performing biliary therapy in endoscopic retrograde cholangiopancreatography (ERCP) are to achieve selective biliary cannulation and prevent post-ERCP pancreatitis (PEP). Nonsteroidal anti-inflammatory drugs have proven prophylactic effect in PEP. However, the patient population that would benefit from this approach has not been defined. A total of 539 patients undergoing our cannulation protocol with early precut were randomized into a placebo-controlled, prospective, double-blind study to rectally receive either 100 mg indomethacin or placebo. The effect of indomethacin on PEP was stratified based on difficulties of cannulation and analyzed in patients with different risks. In 70.3% of patients, biliary intubation was successful in the first 5 atraumatic attempts, PEP rate was low, and indomethacin was ineffective (7.4% in the placebo group and 5.2% in the indomethacin group, P=0.406). In the next phase of intubation using guidewire, the success rate increased up to 83.5%, and PEP rate rose up to 8.7%, the effect of indomethacin was significant (11.9% vs. 5.4%, P=0.018). Applying early precut success rate of biliary cannulation increased up to 98.1% and overall indomethacin diminished ...Continue Reading

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Citations

Jan 24, 2017·Digestive Endoscopy : Official Journal of the Japan Gastroenterological Endoscopy Society·Chongrong ShenPeizhu Su
Dec 4, 2016·Digestive Endoscopy : Official Journal of the Japan Gastroenterological Endoscopy Society·Yunlu FengAiming Yang
Apr 6, 2018·Indian Journal of Gastroenterology : Official Journal of the Indian Society of Gastroenterology·Rajat GargTarun Rustagi
Jul 8, 2018·Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract·Xiaoyu KangXuegang Guo
Oct 20, 2018·Current Treatment Options in Gastroenterology·Han ZhangJames Buxbaum
Jan 28, 2020·Revista Española De Enfermedades Digestivas : Organo Oficial De La Sociedad Española De Patología Digestiva·Jesús García-Cano, Miriam Viñuelas Chicano
Nov 23, 2017·United European Gastroenterology Journal·Jasmin FeluxMartin Goetz
Sep 27, 2018·Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract·Lan LiuHaiyan Jin
May 1, 2021·Pancreatology : Official Journal of the International Association of Pancreatology (IAP) ... [et Al.]·Zsolt DubravcsikLászló Madácsy
Aug 7, 2021·Pancreatology : Official Journal of the International Association of Pancreatology (IAP) ... [et Al.]·Katalin MártaPéter Hegyi

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