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Can postendoscopic retrograde cholangiopancreatography pancreatitis be prevented by a pharmacological approach?
Korean J Intern Med. 2013 Mar; 28(2):141-8.KJ

Abstract

Acute pancreatitis remains the most frequent complication of endoscopic retrograde cholangiopancreatography (ERCP), with reported incidence rates that have changed little over several decades. Patient- and procedure-related risk factors for post-ERCP pancreatitis (PEP) are well-defined. Effective measures to prevent PEP have been identified, including improvements in cannulation techniques and pancreatic stenting, as well as pharmacological intervention. Pharmacotherapy has been widely studied in the prevention of PEP, but the effect in averting PEP has been inconclusive. Although pharmacological prophylaxis is appealing, attempts to find an ideal drug are incomplete. Most available data on the efficacy of pharmacological agents for PEP prophylaxis have been obtained from patients at average risk for PEP. However, recently, a randomized prospective controlled trial of rectal nonsteroidal anti-inflammatory drugs (NSAIDs) to prevent PEP in high-risk patients was published. The results revealed that rectal indomethacin reduced the incidence of PEP significantly. Thus, rectal administration of diclofenac or indomethacin immediately before or after ERCP is used routinely to prevent PEP. However, additional studies with NSAIDs using large numbers of subjects are necessary to confirm the prophylactic effect of these drugs and to establish whether they act synergistically with other prophylactic interventions, including pancreatic stenting.

Authors+Show Affiliations

Digestive Disease Center, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea. yksky001@hanmail.net

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

23525264

Citation

Cheon, Young Koog. "Can Postendoscopic Retrograde Cholangiopancreatography Pancreatitis Be Prevented By a Pharmacological Approach?" The Korean Journal of Internal Medicine, vol. 28, no. 2, 2013, pp. 141-8.
Cheon YK. Can postendoscopic retrograde cholangiopancreatography pancreatitis be prevented by a pharmacological approach? Korean J Intern Med. 2013;28(2):141-8.
Cheon, Y. K. (2013). Can postendoscopic retrograde cholangiopancreatography pancreatitis be prevented by a pharmacological approach? The Korean Journal of Internal Medicine, 28(2), 141-8. https://doi.org/10.3904/kjim.2013.28.2.141
Cheon YK. Can Postendoscopic Retrograde Cholangiopancreatography Pancreatitis Be Prevented By a Pharmacological Approach. Korean J Intern Med. 2013;28(2):141-8. PubMed PMID: 23525264.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Can postendoscopic retrograde cholangiopancreatography pancreatitis be prevented by a pharmacological approach? A1 - Cheon,Young Koog, Y1 - 2013/02/27/ PY - 2012/08/16/received PY - 2012/12/14/accepted PY - 2013/3/26/entrez PY - 2013/3/26/pubmed PY - 2013/12/16/medline KW - Anti-inflammatory agents, non-steroidal KW - Cholangiopancreatography, endoscopic retrograde KW - Pancreatitis KW - Prevention and control SP - 141 EP - 8 JF - The Korean journal of internal medicine JO - Korean J. Intern. Med. VL - 28 IS - 2 N2 - Acute pancreatitis remains the most frequent complication of endoscopic retrograde cholangiopancreatography (ERCP), with reported incidence rates that have changed little over several decades. Patient- and procedure-related risk factors for post-ERCP pancreatitis (PEP) are well-defined. Effective measures to prevent PEP have been identified, including improvements in cannulation techniques and pancreatic stenting, as well as pharmacological intervention. Pharmacotherapy has been widely studied in the prevention of PEP, but the effect in averting PEP has been inconclusive. Although pharmacological prophylaxis is appealing, attempts to find an ideal drug are incomplete. Most available data on the efficacy of pharmacological agents for PEP prophylaxis have been obtained from patients at average risk for PEP. However, recently, a randomized prospective controlled trial of rectal nonsteroidal anti-inflammatory drugs (NSAIDs) to prevent PEP in high-risk patients was published. The results revealed that rectal indomethacin reduced the incidence of PEP significantly. Thus, rectal administration of diclofenac or indomethacin immediately before or after ERCP is used routinely to prevent PEP. However, additional studies with NSAIDs using large numbers of subjects are necessary to confirm the prophylactic effect of these drugs and to establish whether they act synergistically with other prophylactic interventions, including pancreatic stenting. SN - 2005-6648 UR - https://www.unboundmedicine.com/medline/citation/23525264/Can_postendoscopic_retrograde_cholangiopancreatography_pancreatitis_be_prevented_by_a_pharmacological_approach L2 - https://dx.doi.org/10.3904/kjim.2013.28.2.141 DB - PRIME DP - Unbound Medicine ER -