Efficacy of low dose rectal diclofenac for preventing post‐endoscopic retrograde cholangiopancreatography pancreatitis: Propensity score‐matched analysis

Abstract

Background: Acute pancreatitis is a major adverse event of endoscopic retrograde cholangiopancreatography (ERCP). Rectal administration of non-steroidal anti-inflammatory drugs (NSAIDs) decreases the incidence of post-ERCP pancreatitis (PEP). However, the efficacy of low dose rectal NSAIDs for preventing PEP remains controversial. Methods:We performed a retrospective study of 301 patients with native papilla and a body weight of <50 kg who underwent ERCP between September 2010 and October 2019. After July 2016, a 25 mg dose of rectal diclofenac was routinely administered within 15 min before ERCP (NSAIDs group, n = 72) and the control group (n = 229) consisted of patients undergoing ERCP before this date without treatment. We compared the incidence of PEP between the two groups using propensity score matching.Results: A total of 66 pairs of patients in each group were selected. The patients and procedural-related factors were similar in both groups. In total, 15 patients (11.4%) developed PEP: 12.1% (8/66) in the NSAIDs group and 10.6% (7/66) in the control group (Odds ratio (OR) 1.2; 95% confidence interval (CI) 0.4-3.5; P = 0.78). There was no significant difference in incidence of other adverse events related to ERCP between the two groups.Conclusions: Prophylactic administration of a 25 mg dose of rectal diclofenac did not reduce the incidence of PEP in patients with a native papilla and a body weight of <50 kg in this study and a certain dose of rectal NSAIDs, such as a 100-mg dose, should be administered regardless of body weight to prevent PEP.

Multicenter prospective cohort study of adverse events associated with biliary endoscopic retrograde cholangiopancreatography: Incidence of adverse events and preventive measures for post‐endoscopic retrograde cholangiopancreatography pancreatitis

“…Rectal administration of low‐dose NSAIDs before ERCP did not show any preventive effect. This finding was consistent with previous studies 19,20 . On the other hand, administration of NSAIDs after ERCP was significantly high risk in the multivariable analysis.…”

“…This finding was consistent with previous studies. 19,20 On the other hand, administration of NSAIDs after ERCP was significantly high risk in the multivariable analysis. This suggests that post-ERCP NSAIDs reflect various factors related to operator's choice such as the actual difficulty of the procedures and the patient conditions.…”

Update on the management of acute pancreatitis

“…Moreover, a pancreatic duct (PD) stent is placed in case of unintentional PD cannulation. A Japanese propensity-score matched analysis shows that low dose diclofenac (25 mg) in patients with a body weight <50 kg is not effective [25]. A large international prospective observational study has shown no protective effect of chronic statin and aspirin use [26].…”

Efficacy of pancreatic duct stenting to prevent postendoscopic retrograde cholangiopancreatography pancreatitis after covered self‐expandable metal stent deployment

“…1 Various studies focusing on preventing the occurrence of PEP have reported aggressive intravenous hydration with lactated Ringer's solution, rectal nonsteroidal antiinflammatory drugs (NSAIDs), and pancreatic duct (PD) stenting to be effective. 2,3 Deploying a covered self-expandable metal stent (CSEMS) is preferred for biliary drainage treatment for malignant biliary obstruction (MBO) because of its replaceability and longer patency period. 4,5 Prolonged lifetime of patients with unresectable pancreatobiliary cancers and the development of neoadjuvant therapy for resectable cancers underlie this trend.…”

“…Endoscopic retrograde cholangiopancreatography (ERCP) is a crucial method for diagnosing and treating pancreatobiliary diseases; however, post‐ERCP pancreatitis (PEP) is estimated to occur in 4.5% of cases 1 . Various studies focusing on preventing the occurrence of PEP have reported aggressive intravenous hydration with lactated Ringer's solution, rectal nonsteroidal anti‐inflammatory drugs (NSAIDs), and pancreatic duct (PD) stenting to be effective 2,3 . Deploying a covered self‐expandable metal stent (CSEMS) is preferred for biliary drainage treatment for malignant biliary obstruction (MBO) because of its replaceability and longer patency period 4,5 .…”