Mia Rainio1, Outi Lindström2, Marianne Udd2, Johanna Louhimo2, Leena Kylänpää2. 1. Department of Gastrointestinal Surgery, University of Helsinki, Helsinki University Hospital, Haartmaninkatu 4, 00290, Helsinki, Finland. mia.rainio@hus.fi. 2. Department of Gastrointestinal Surgery, University of Helsinki, Helsinki University Hospital, Haartmaninkatu 4, 00290, Helsinki, Finland.
Abstract
BACKGROUND: Nonsteroidal anti-inflammatory drugs have an inhibitory role in pathogenesis of pancreatitis. Guidelines from the European Society of Gastrointestinal Endoscopy recommend routine rectal administration of 100 mg of diclofenac or indomethacin immediately before or after ERCP for all patients without contraindications. AIMS: Our aim was to evaluate the effect of diclofenac in preventing post-ERCP pancreatitis (PEP) in a high-volume, low-PEP-risk ERCP unit. METHODS: The rate and severity of PEP were compared in groups of 1000 historical controls prior to the routine use of diclofenac and in 1000 patients receiving 100 mg diclofenac before ERCP. RESULTS: PEP occurred in 56 (2.8%) of the 2000 patients, and the rate of the pancreatitis was 2.8% in control group and 2.8% in diclofenac group (p = 1.000). The PEP rate among the native papilla patients was 3.9% in control group and 3.6% in diclofenac group (p = 0.803). In subgroup analysis of patients with a high risk of PEP, diclofenac neither prevented PEP nor made its course milder. CONCLUSIONS: In an unselected patient population in a center with a low incidence of PEP, diclofenac seems to have no beneficial effect.
BACKGROUND: Nonsteroidal anti-inflammatory drugs have an inhibitory role in pathogenesis of pancreatitis. Guidelines from the European Society of Gastrointestinal Endoscopy recommend routine rectal administration of 100 mg of diclofenac or indomethacin immediately before or after ERCP for all patients without contraindications. AIMS: Our aim was to evaluate the effect of diclofenac in preventing post-ERCP pancreatitis (PEP) in a high-volume, low-PEP-risk ERCP unit. METHODS: The rate and severity of PEP were compared in groups of 1000 historical controls prior to the routine use of diclofenac and in 1000 patients receiving 100 mg diclofenac before ERCP. RESULTS:PEP occurred in 56 (2.8%) of the 2000 patients, and the rate of the pancreatitis was 2.8% in control group and 2.8% in diclofenac group (p = 1.000). The PEP rate among the native papillapatients was 3.9% in control group and 3.6% in diclofenac group (p = 0.803). In subgroup analysis of patients with a high risk of PEP, diclofenac neither prevented PEP nor made its course milder. CONCLUSIONS: In an unselected patient population in a center with a low incidence of PEP, diclofenac seems to have no beneficial effect.
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