Year 2024 / Volume 116 / Number 4
Original
Effect of rectal indomethacin on the prevention of pancreatitis after endoscopic retrograde cholangiopancreatography for choledocholithiasis: a prospective randomized clinical trial

20-208

DOI: 10.17235/reed.2023.9899/2023

Kai-Ji Liu, Yang Hu, Shi-Bin Guo,

Abstract
Background and aim: the aim of this study was to evaluate the efficacy and safety of rectal indomethacin for the prevention of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) in patients with common bile duct (CBD) stones. Methods: a total of 167 patients undergoing ERCP between November 2019 and November 2022 for CBD stones in the First Affiliated Hospital of Dalian Medical University were prospectively analyzed. The patients were divided into an indomethacin group (n = 58) and a control group (n = 109). The primary endpoint was the percent of patients who experienced PEP. Results: PEP was observed in a total of 26 patients (15.57 %); four patients (6.90 %) in the indomethacin group and 22 (20.18 %) in the control group (p = 0.042). Mild, moderate and severe PEP was observed in three (5.17 %), one (1.72 %) and zero patients, respectively, in the indomethacin group, and in eleven (10.09 %), nine (8.26 %) and two (1.83 %) patients, respectively, in the control group. There was one case (0.92 %) of death due to PEP in the control group. No cases of moderate or severe bleeding were observed in either group. Conclusions: rectal indomethacin is an effective and safe method to prevent PEP for patients with CBD stones undergoing ERCP.
Lay Summary
Therapeutic endoscopic retrograde cholangiopancreatography (ERCP) has been widely accepted as the standard therapy for removing common bile duct (CBD) stones, but complications of the procedure are difficult to completely avoid, among them, post-ERCP pancreatitis (PEP) is the most common. Rectal indomethacin is recommend by the European Society for Gastrointestinal Endoscopy to prevent PEP, but some studies showed different results, and speculated that only high-risk patients benefit. To evaluate the efficacy and safety of rectal indomethacin for prevention of PEP in patients with CBD stones, a total of 167 patients were divided into an indomethacin group (n=58) and a control group (n=109). Rectal indomethacin (100mg) was administrated 5 min before the ERCP procedure in the indomethacin group, while placebo was given in the control group. The study showed that 100 mg of rectal indomethacin could decrease the risk of PEP in patients undergoing ERCP for treatment of CBD stones without increasing adverse events such as bleeding.
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Liu K, Hu Y, Guo S. Effect of rectal indomethacin on the prevention of pancreatitis after endoscopic retrograde cholangiopancreatography for choledocholithiasis: a prospective randomized clinical trial. 9899/2023


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Publication history

Received: 09/08/2023

Accepted: 15/11/2023

Online First: 20/11/2023

Published: 09/04/2024

Article revision time: 65 days

Article Online First time: 103 days

Article editing time: 244 days


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