Indomethacin May Reduce the Incidence and Severity of Acute Pancreatitis After ERCP

Sotoudehmanesh, Rasoul; Khatibian, Morteza; Kolahdoozan, Shadi; Ainechi, Sanaz; Malboosbaf, Ramin; Nouraie, Mehdi

doi:10.1111/j.1572-0241.2007.01165.x

Cited by 189 publications

(181 citation statements)

References 19 publications

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“…This seems to indicate that the vulnerability of the pancreas declines with age. In this connection, the finding of Sotoudehmanesh et al [23] that the risk for post-ERCP pancreatitis is reduced in patients above the age of 60 years is of interest.…”

Section: Discussionmentioning

confidence: 99%

First attack of acute pancreatitis in Sweden 1988 – 2003: incidence, aetiological classification, procedures and mortality – a register study

et al. 2009

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BackgroundPopulation-based studies suggest that the incidence of first attack of acute pancreatitis (FAAP) is increasing and that old age is associated with increased mortality. Beacuse nationwide data are limited and information on standardized mortality ratio (SMR) versus age is lacking, we wanted to describe incidence and mortality of first attack acute pancreatitis (FAAP) in Sweden.MethodsHospital discharge data concerning diagnoses and surgical procedures and death certificate data were linked for patients with FAAP in Sweden. Mortality was calculated as case fatality rate (CFR), i.e. deaths per 1000 patients and SMR using age-, gender- and calendar year-specific expected survival estimates, and is given as mean with 95% confidence intervals. Data are presented as median values with 25% and 75% percentiles, means and standard deviations, or proportions. Proportions have been compared using the chi square test, Poisson-regression test or Fisher exact test. Location of two groups of ratio scale variables were compared using independent samples t-test or Mann-Whitney U-test.ResultsFrom 1988 through 2003, 43415 patients (23801 men and 19614 women) were admitted for FAAP. Age adjusted incidence rose from 27.0 to 32.0 per 100000 individuals and year. Incidence increased with age for both men and women. At index stay 19.7% of men and 35.4% of women had biliary diagnoses, and 7.1% of men and 2.1% of women alcohol-related diagnoses. Of 10072 patients who underwent cholecystectomy, 7521 (74.7%) did so after index stay within the audit period. With increasing age CFR increased and SMR decreased. For the whole period studied SMR was 11.75 (11.34–12.17) within 90 days of index admission and 2.03 (1.93–2.13) from 91 to 365 days. Alcohol-related diagnoses and young age was associated with increased SMR. Length of stay and SMR decreased significantly during the audit period.ConclusionIncidence of FAAP increased slightly from 1988 to 2003. Incidence increased and SMR declined with increasing patient age. Although the prognosis for patients with FAAP has improved it remains an important health problem. Aetiological classification at index stay and timing of cholecystectomy should be improved.

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Section: Discussionmentioning

confidence: 99%

First attack of acute pancreatitis in Sweden 1988 – 2003: incidence, aetiological classification, procedures and mortality – a register study

et al. 2009

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“…Two studies were excluded beacuse full texts in English were not retrieved (17)(18). Finally, three studies involving a total of 1242 patients were included for data extraction (14)(15)(16). Except for one single-center study, two studies were designed as multicenter.…”

Section: Study Selection and Quality Assessmentmentioning

confidence: 99%

“…After initial screening, five relevant prospective studies were identified for evaluation in details (14)(15)(16)(17)(18). Two studies were excluded beacuse full texts in English were not retrieved (17)(18).…”

Section: Study Selection and Quality Assessmentmentioning

confidence: 99%

Rectal indomethacin for the prevention of post-ERCP pancreatitis: A meta-analysis of randomized controlled trials

Shi¹,

Deng²,

Altaf³

et al. 2015

Turk J Gastroenterol

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Background/Aims: This meta-analysis was undertaken to evaluate the effect of rectal indomethacin in the prevention of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. Materials and Methods: Major databases including Embase, Medline, Science Citation Index Expanded, Pubmed and the Cochrane Central Register of Controlled Trials, were searched to identify all relevant studies from January 1960 to July 2013. Randomized controlled trials (RCTs) comparing prophylactic use of rectal indomethacin versus placebo were included. Risk ratio (RR) with 95% confidence interval (CI) was calculated using fixed-or randomeffect models. Results: Three studies met the inclusion criteria and were included in the final analyses. The overall incidence of post-ERCP pancreatitis (PEP) was significantly decreased by prophylactic rectal indomethacin compared with the placebo (RR=0.51; 95% CI=0.37-0.70). The pooled incidence of moderate to severe pancreatitis was also decreased by rectal indomethacin prophylaxis (RR=0.43; 95% CI=0.23-0.80). Conclusion: Rectal indomethacin can reduce the overall incidence and the severity of PEP.

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“…There was, however, a significant protective effect among patients with inadvertent pancreatography (2% vs 19%). 132 Khoshbaten et al 133 reported that RNSAIDs significantly reduced PEP (26%-4%) in a study where pancreatography was the criterion for entry.…”

Section: Post-ercp Prophylaxismentioning

confidence: 99%

Endoscopic retrograde cholangiopancreatography complications: Techniques to reduce risk and management strategies

Tarnasky

Kedia

2017

Int J Gastrointest Interv

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Adverse events after endoscopic retrograde cholangiopancreatography (ERCP) are not uncommon and can be associated with tragic outcomes. Bleeding, perforation, and post-ERCP pancreatitis are the most common complications. Some events are unavoidable; others are associated with well described risk factors so that they can be either anticipated and/or measures can be taken for prevention or at least risk reduction. This review will focus on the more common complications after ERCP, their risk factors, and potential strategies for risk reduction. Additionally, recommendations for management of ERCP complications will be presented.

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Indomethacin May Reduce the Incidence and Severity of Acute Pancreatitis After ERCP

Abstract: This trial shows that rectal indomethacin given immediately before ERCP can reduce the incidence and severity of post-ERCP pancreatitis.

Cited by 189 publications

References 19 publications

First attack of acute pancreatitis in Sweden 1988 – 2003: incidence, aetiological classification, procedures and mortality – a register study

First attack of acute pancreatitis in Sweden 1988 – 2003: incidence, aetiological classification, procedures and mortality – a register study

Rectal indomethacin for the prevention of post-ERCP pancreatitis: A meta-analysis of randomized controlled trials

Endoscopic retrograde cholangiopancreatography complications: Techniques to reduce risk and management strategies

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