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Digestive Diseases and Sciences

, Volume 60, Issue 8, pp 2509–2515 | Cite as

A Trial of Rectal Indomethacin to Prevent Post-ERCP Pancreatitis in Patients with Suspected Type 3 Sphincter of Oddi Dysfunction

  • Ali A. Siddiqui
  • Devi Patel
  • Jeremy Kaplan
  • Andrew H. Zabolotsky
  • David Loren
  • Thomas Kowalski
  • Saad S. Ghumman
  • Douglas G. Adler
  • Satish Munigal
  • Umar Hayat
  • Mohamad A. Eloubeidi
Original Article

Abstract

Background and Aim

Recent data have suggested that rectal indomethacin can also reduce the incidence of post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP). The aim of this study was to determine whether prophylactic rectal indomethacin with PD stenting would reduce the incidence and severity of PEP compared to PD stenting alone in patients undergoing manometry for suspected SOD type 3.

Patients and Methods

A retrospective review of consecutive patients who underwent an ERCP with manometry for suspected SOD type 3 was performed. Patients were divided into two groups: (a) those who received a prophylactic PD stent (n = 285) and (b) those who received a prophylactic PD stent and a single dose of 100-mg indomethacin suppositories after ERCP (n = 57). The rate of PEP was compared between the two groups.

Results

The two patient groups were similar with regard to patient and procedure risk factors for PEP. Post-ERCP pancreatitis developed in 22 % patients. There was no significant difference in the incidence of PEP in the PD stent group compared to the PD stent and indomethacin group (23 vs. 18 %, respectively; p = 0.39). Moderate-to-severe pancreatitis developed in 21 (7 %) patients in the PD stent group compared to 5 (9 %) patients in the PD stent and indomethacin group (p = 0.78). Among patients with PEP, the median length of hospital stay was not significantly longer in the PD stent group compared to the PD stent and indomethacin group (6 vs. 4 days, respectively; p = 0.11).

Conclusions

In patients with suspected SOD type 3, prophylactic rectally administered indomethacin with PD stenting was not observed to affect the incidence or severity of post-ERCP pancreatitis when compared to PD stenting alone.

Keywords

Acute pancreatitis Endoscopic retrograde cholangiopancreatography Indomethacin Sphincter of Oddi dysfunction 

Notes

Acknowledgments

This study was funded entirely through existing intramural funds and salary support.

Conflict of interest

None.

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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Ali A. Siddiqui
    • 1
  • Devi Patel
    • 1
  • Jeremy Kaplan
    • 1
  • Andrew H. Zabolotsky
    • 1
  • David Loren
    • 1
  • Thomas Kowalski
    • 1
  • Saad S. Ghumman
    • 1
  • Douglas G. Adler
    • 2
  • Satish Munigal
    • 3
  • Umar Hayat
    • 1
  • Mohamad A. Eloubeidi
    • 4
  1. 1.Division of Gastroenterology and Hepatology, Department of Internal MedicineThomas Jefferson University HospitalPhiladelphiaUSA
  2. 2.Division of Gastroenterology and Hepatology, Department of Internal MedicineUniversity of UtahSalt Lake CityUSA
  3. 3.Department of Internal MedicineWashington University School of MedicineSt. LouisUSA
  4. 4.Division of GastroenterologyNortheast Alabama Regional Medical CenterAnnistonUSA

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