Year 2018 / Volume 110 / Number 8
Original
Rectal diclofenac does not prevent post-ERCP pancreatitis in consecutive high-risk and low-risk patients

505-509

DOI: 10.17235/reed.2018.5259/2017

Lourdes del Olmo Martínez, Benito Velayos Jiménez, Ana Almaraz Gómez,

Abstract
Objective: rectal diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) that is used to prevent pancreatitis in high-risk patients during endoscopic retrograde cholangiopancreatography (ERCP). The European Society of Gastrointestinal Endoscopy (ESGE) recommends the use of prophylaxis with indomethacin or diclofenac in all patients undergoing ERCP, including those at low or intermediate risk of pancreatitis. A study to investigate the efficacy of this recommendation was performed. Methods: this was a mixed cohort study. A total of 1,512 ERCP procedures performed in our institution from January 2009 to July 2016 were included in the study. Until June 2012, 718 patients did not receive diclofenac. Subsequently, 794 patients without contraindications received 100 mg of rectal diclofenac at the onset of the procedure. Risk factors for post-ERCP pancreatitis (PEAP) and PEAP cases defined using consensus criteria were recorded. Results: a total of 47 PEAP events (3.1%) were reported, 3.4% in the diclofenac group and 2.8% in the non-diclofenac group (p = 0.554); 26.1% of patients had risk factors for PEAP. In the diclofenac group, PEAP developed in 4.4%, 0.5% and 2.6% of subjects with intact papillae, prior sphincterotomy and extended sphincterotomy, respectively. The results were similar for the non-diclofenac group: 4% with intact papillae, 0.9% with prior sphincterotomy, and 2.5% with extended sphincterotomy, respectively. PEAP severity was similar in both groups. Conclusions: rectal diclofenac before ERCP did not prevent the development of post-ERCP acute pancreatitis in non-selected consecutive patients.
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del Olmo Martínez L, Velayos Jiménez B, Almaraz Gómez A. Rectal diclofenac does not prevent post-ERCP pancreatitis in consecutive high-risk and low-risk patients. 5259/2017


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Publication history

Received: 13/09/2017

Accepted: 04/02/2018

Online First: 18/04/2018

Published: 30/07/2018

Article revision time: 125 days

Article Online First time: 217 days

Article editing time: 320 days


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