Diclofenac Does Not Reduce the Risk of Post-endoscopic Retrograde Cholangiopancreatography Pancreatitis in Low-Risk Units

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 patient...

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Bibliographic Details
Published in:Journal of gastrointestinal surgery 2017-08, Vol.21 (8), p.1270-1277
Main Authors: Rainio, Mia, Lindström, Outi, Udd, Marianne, Louhimo, Johanna, Kylänpää, Leena
Format: Article
Language:English
Subjects:
Administration, Rectal
Adolescent
Adult
Aged
Aged, 80 and over
Anti-Inflammatory Agents, Non-Steroidal - administration & dosage
Anti-Inflammatory Agents, Non-Steroidal - therapeutic use
Cholangiopancreatography, Endoscopic Retrograde - adverse effects
Diclofenac - administration & dosage
Diclofenac - therapeutic use
Female
Gastroenterology
Gastrointestinal surgery
Hospital Units - statistics & numerical data
Hospitals, High-Volume - statistics & numerical data
Humans
Male
Medicine
Medicine & Public Health
Middle Aged
Nonsteroidal anti-inflammatory drugs
Original Article
Pancreatitis - etiology
Pancreatitis - prevention & control
Risk Factors
Surgery
Young Adult
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Summary: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.
ISSN:1091-255X
1873-4626
DOI:10.1007/s11605-017-3412-3