Skip to main content

Advertisement

SpringerLink
Log in

Can Rectal Diclofenac Prevent Post Endoscopic Retrograde Cholangiopancreatography Pancreatitis?

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background

Non steroidal anti-inflammatory drugs (NSAIDs) have been shown to reduce the incidence of post endoscopic retrograde cholangiopancreatography pancreatitis (PEP). There were various trials using different routes and dosages of NSAIDs but meta-analysis revealed inconsistent results.

Aims

The aims of this study were to determine the efficacy of rectal diclofenac in preventing PEP and to evaluate any adverse events.

Methods

This was a randomized, open-label, two-arm, prospective clinical trial. Only patients at high risk of developing PEP were recruited. They received 100 mg rectal diclofenac or no intervention immediately after ERCP. The patients were reviewed 30 days after discharge to evaluate any adverse event.

Results

Among 144 recruited patients, 69 (47.9 %) received diclofenac and 75 (52.1 %) had no intervention. Eleven patients (7.6 %) developed PEP, in which seven were from the diclofenac group and four were in the control group. Eight cases of PEP (5.5 %) were mild and three cases (2.1 %) were moderate. The differences in pancreatitis incidence and severity between both groups were not statistically significant. There were 11 adverse events reported. Clinically significant bleeding happened in four patients (2.8 %): one from the diclofenac group and three from the control group. Other events included cholangitis: two patients (2.9 %) from the diclofenac group and four (5.3 %) from the control group. One patient from the diclofenac group (1.4 %) had a perforation which was treated conservatively.

Conclusions

In summary, prophylactic rectal diclofenac did not significantly decrease the incidence of PEP among patients at high risk for developing PEP. However, the administration of diclofenac was fairly safe with few clinical adverse events.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. McCune WS, Shorb PE, Moscovitz H. Endoscopic cannulation of the ampulla of vater: a preliminary report. Ann Surg. 1968;167:752–756.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  2. Peel AL, Hermon-Taylor J, Ritchie HD. Technique of transduodenal exploration of the common bile duct. Duodenoscopic appearances after biliary sphincterotomy. Ann R Coll Surg Engl. 1974;55:236–244.

    PubMed Central  CAS  PubMed  Google Scholar 

  3. Freeman ML, Guda NM. Prevention on post-ERCP pancreatitis: a comprehensive review. Gastrointest Endosc. 2004;59:64.

    Google Scholar 

  4. Murray B, Carter R, Imrie C, Evans S, O’Suilleabhain C. Diclofenac reduces the incidence of acute pancreatitis after endoscopic retrograde cholangiopancreatography. Gastroenterology. 2003;124:1786–1791.

    Article  CAS  PubMed  Google Scholar 

  5. Sotoudehmanesh R, Khatibian M, Kolahdoozan S, Ainechi S, Malboosbaf R, Nouraie M. Indomethacin may reduce the incidence and severity of acute pancreatitis after ERCP. Am J Gastroenterol. 2007;102:978–983.

    Article  CAS  PubMed  Google Scholar 

  6. Khoshbaten M, Khorram H, Mamad L, Ehsani Ardakani MJ, Farzin H, Zali MR. Role of diclofenac in reducing postendoscopic retrograde cholangiopancreatography pancreatitis. J Gastroenterol Hepatol. 2008;23:e11–e16.

    Article  CAS  PubMed  Google Scholar 

  7. Monta. o Loza A, Rodríguez Lomeli X, García Correa JE, et al. Effect of rectal administration of indomethacin on amylase serum levels after endoscopic retrograde cholangiopancreatography, and its impact on the development of secondary pancreatitis episodes. Rev Esp Enferm Dig. 2007;99:330–336. (in Spanish).

    Google Scholar 

  8. Elmunzer BJ, Waljee AK, Elta GH, Taylor JR, Fehmi SM, Higgins PD. A metaanalysis of rectal NSAIDs in the prevention of post-ERCP pancreatitis. Gut. 2008;57:1262–1267.

    Article  CAS  PubMed  Google Scholar 

  9. Gross V, Leser HG, Heinisch A, et al. Inflammatory mediators and cytokines—new aspects of the pathophysiology and assessment of severity of acute pancreatitis? Hepatogastroenterology. 1993;40:522–530.

    CAS  PubMed  Google Scholar 

  10. Ding XW. Non steroidal anti-inflammatory drugs for prevention of post-ERCP pancreatitis: a meta-analysis. Gastrointest Endosc. 2012;76:1152–1159.

    Article  PubMed  Google Scholar 

  11. Tarnasky PR, Palesch YY, Cunningham JT, Mauldin PD, Cotton PB, Hawes RH. Pancreatic stenting prevents pancreatitis after biliary sphincterotomy in patients with sphincter of Oddi dysfunction. Gastroenterology. 1998;115:1518–1524.

    Article  CAS  PubMed  Google Scholar 

  12. Fazel A, Quadri A, Catalano MF, Meyerson SM, Geenen JE. Does a pancreatic duct stent prevent post-ERCP pancreatitis? A prospective randomized study. Gastrointest Endosc. 2003;57:291–294.

    Article  PubMed  Google Scholar 

  13. Singh P, Das A, Isenberg G, et al. Does prophylactic pancreatic stent placement reduce the risk of post-ERCP pancreatitis? A meta-analysis of controlled trials. Gastrointest Endosc. 2004;60:544–550.

    Article  PubMed  Google Scholar 

  14. Freeman ML. Pancreatic stents for prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis. Clin Gastroenterol Hepatol. 2007;5:1354–1365.

    Article  PubMed  Google Scholar 

  15. Cotton PB, Lehman G, Vennes J, et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc. 1991;37:383–393.

    Article  CAS  PubMed  Google Scholar 

  16. Bilbao MK, Dotter CT, Lee TG, Katon RM. Complications of endoscopic retrograde cholangiopancreatography (ERCP): a study of 10,000 cases. Gastroenterology. 1976;70:314–320.

    CAS  PubMed  Google Scholar 

  17. Sand J, Nordback I. Prospective randomised trial of the effect of nifedipine on pancreatic irritation after endoscopic retrograde cholangiopancreatography. Digestion. 1993;54:105–111.

    Article  CAS  PubMed  Google Scholar 

  18. Messman H, Vogt W, Holstege A, et al. Post-ERCP pancreatitis as a model for cytokine induced acute phase response in acute pancreatitis. Gut. 1997;40:80–85.

    Article  Google Scholar 

  19. Ito K, Fujita N, Noda Y, et al. Can pancreatic duct stenting prevent post-ERCP pancreatitis in patients who undergo pancreatic duct guide wire placement for achieving selective biliary cannulation? A prospective randomized controlled trial. J Gastroenterol. 2010;45:1183–1191.

    Article  PubMed  Google Scholar 

  20. Mazaki T, Masuda H, Takayama T. Prophylactic pancreatic stent placement and post-ERCP pancreatitis: a systematic review and meta analysis. Endoscopy. 2010;42:842–853.

    Article  CAS  PubMed  Google Scholar 

  21. Mäkelä A, Kuusi T, Schröder T. Inhibition of serum phospholipase-A2 in acute pancreatitis by pharmacological agents invitro. Scand J Clin Lab Invest. 1997;57:401–408.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We would like to express our gratitude to the Director General of Health and the Ministry of Health Malaysia for approving and supporting this clinical trial. We would also like to thank the statistician and all the staff from Clinical Research Center Kota Kinabalu for their contribution in the study.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Ministry of Health, Kota Kinabalu, Malaysia

    Guan Way Lua, Raman Muthukaruppan & Jayaram Menon

Authors
  1. Guan Way Lua
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Raman Muthukaruppan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jayaram Menon
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Guan Way Lua.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lua, G.W., Muthukaruppan, R. & Menon, J. Can Rectal Diclofenac Prevent Post Endoscopic Retrograde Cholangiopancreatography Pancreatitis?. Dig Dis Sci 60, 3118–3123 (2015). https://doi.org/10.1007/s10620-015-3609-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-015-3609-9

Keywords

Search

Navigation