Role of diclofenac in reducing post‐endoscopic retrograde cholangiopancreatography pancreatitis

Abstract

Wang ZH, Mo JZ, Xiao SD. Effects of thalidomide in experimental models of post-endoscopic retrograde cholangiopancreatography pancreatitis. J. Gastroenterol. Hepatol. 2007; 22: 371-6. 18 He ZJ, Winston JH, Yusuf Te et al. Intraductal administration of an NK1 receptor antagonist attenuates the inflammatory response to retrograde infusion of radiological contrast in rats: implications for the pathogenesis and prevention of ERCP-induced pancreatitis. Pancreas 2003; 27: e13-7. 19 Khoshbaten M, Khorram H, Madad L, Ardakani MJE, Farzin H, Zali MR. Role of diclofenac in reducing post-endoscopic retrograde cholangiopancreatography pancreatitis. Andriulli A, Leandro G, Federici T et al. Prophylactic administration of somatostatin or gabexate does not prevent pancreatitis after ERCP: an updated meta-analysis. Gastrointest. Endosc. 2007; 65: 624-32. 22 Rudin D, Kiss A, Wetz RV, Sottile VM. Somatostatin and gabexate for post-endoscopic retrograde cholangiopancreatography pancreatitis prevention: meta-analysis of randomized placebo controlled trials. J. Gastroenterol. Hepatol. 2007; 22: 977-83. 23 Thomopoulos KC, Pagoni NA, Vagenas KA, Margaritis VG, Theocharis GI, Nikolopoulou VN. Twenty-four hour prophylaxis with increased dosage of octreotide reduces the incidence of post-ERCP pancreatitis. Gastrointest. Endosc. 2006; 64: 726-31. 24 Singh P, Das A, Isenberg G et al. Do prophylactic stent placement reduces risk of post-ERCP acute pancreatitis: a meta-analysis of controlled trials. Gastrointest. Endosc. 2004; 60: 544-50. 25 Andriulli A, Forlano R, Napolitano G et al. Pancreatic duct stents in the prophylaxis of pancreatic damage after endoscopic retrograde cholangiopancreatography: a systematic analysis of benefits and associated risks. Digestion 2007; 75: 156-63. 26 Das A, Singh P, Sivak MV Jr et al. Pancreatic stent placement for prevention of post-ERCP pancreatitis: a cost effectiveness analysis. Gastrointest. Endosc. 2007; 65: 960-8. 27 Freeman ML, Overby C, Qi D. Pancreatic stent insertion: consequences of failure and results of a modified technique to maximize success. Gastrointest. Endosc. 2004; 59: 8-14. 28 Sherman S, Hawes RH, Savides TJ et al. Stent-induced pancreatic ductal and parenchymal changes: correlation of endoscopic ultrasound with ERCP. Gastrointest. Endosc. 1996; 44: 276-82. 29 Rashdan A, Fogel EL, McHenry L Jr, Sherman S, Temkit M, Lehman GA. Improved stent characteristics for prophylaxis of post-ERCP pancreatitis. Clin. Gastroenterol. Hepatol. 2004; 2: 322-9. 30 Lawrence C, Cotton PB, Romagnuolo J, Payne KM, Rawls E, Hawes RH. Small prophylactic pancreatic duct stents: an assessment

Efficacy of intramuscular diclofenac and fluid replacement in prevention of post-ERCP pancreatitis

“…This difference was statistically significant, with P < 0.01. No patients in this clinical trial developed necrotizing pancreatitis or required surgical intervention [18,44] . We showed that, in the diclofenac group, pancreatitis was seen less than in the control group, but this was not statistically significant.…”

“…Also, the drug was not effective in the subgroup of patients with SOD, the very group at highest risk [9] . Khoshbaten et al [18] have reported a randomized controlled study that compared 100 mg rectal diclofenac with placebo in 100 patients who underwent high-risk ERCP. To select high-risk cases, only those undergoing pancreatography (with or without cholangiography) were enrolled.…”

“…Diclofenac, a potent inhibitor of phospholipase A 2 activity, administered immediately after the procedure, is effective at preventing pancreatitis [9,18] . Advantages of this prophylaxis are the low cost and the possibility of "on-demand" treatment.…”

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

“…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.…”

How and when should NSAIDs be used for preventing post-ERCP pancreatitis? A systematic review and meta-analysis

“…The results of RCTs using nitroglycerine, ceftazidime, somatostatin, octreotide, antiprotease drugs, glucocorticoids, drugs reducing sphincter of Oddi pressure, antioxidant drugs, heparin, and Interleukin-10 have been disappointing [4]. Some studies have shown a benefit with NSAIDs [10][11][12][13][14][15][16][17][18], but a practice survey study performed some years ago showed that they were not widely used [19]. The main reason quoted was insufficient supporting evidence, but the authors speculate that clinicians' scepticism related to the failure of many other large studies with other pharmacological agents also played an important role.…”