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Can Rectal Diclofenac Prevent Post Endoscopic Retrograde Cholangiopancreatography Pancreatitis?
Dig Dis Sci. 2015 Oct; 60(10):3118-23.DD

Abstract

BACKGROUND

Non steroidal anti-inflammatory drugs (NSAIDs) have been shown to reduce the incidence of post endoscopic retrograde cholangiopancreatography pancreatitis (PEP). There were various trials using different routes and dosages of NSAIDs but meta-analysis revealed inconsistent results.

AIMS

The aims of this study were to determine the efficacy of rectal diclofenac in preventing PEP and to evaluate any adverse events.

METHODS

This was a randomized, open-label, two-arm, prospective clinical trial. Only patients at high risk of developing PEP were recruited. They received 100 mg rectal diclofenac or no intervention immediately after ERCP. The patients were reviewed 30 days after discharge to evaluate any adverse event.

RESULTS

Among 144 recruited patients, 69 (47.9%) received diclofenac and 75 (52.1%) had no intervention. Eleven patients (7.6%) developed PEP, in which seven were from the diclofenac group and four were in the control group. Eight cases of PEP (5.5%) were mild and three cases (2.1%) were moderate. The differences in pancreatitis incidence and severity between both groups were not statistically significant. There were 11 adverse events reported. Clinically significant bleeding happened in four patients (2.8%): one from the diclofenac group and three from the control group. Other events included cholangitis: two patients (2.9%) from the diclofenac group and four (5.3%) from the control group. One patient from the diclofenac group (1.4%) had a perforation which was treated conservatively.

CONCLUSIONS

In summary, prophylactic rectal diclofenac did not significantly decrease the incidence of PEP among patients at high risk for developing PEP. However, the administration of diclofenac was fairly safe with few clinical adverse events.

Authors+Show Affiliations

Ministry of Health, Kota Kinabalu, Malaysia. guanway@hotmail.com.Ministry of Health, Kota Kinabalu, Malaysia.Ministry of Health, Kota Kinabalu, Malaysia.

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

25757446

Citation

Lua, Guan Way, et al. "Can Rectal Diclofenac Prevent Post Endoscopic Retrograde Cholangiopancreatography Pancreatitis?" Digestive Diseases and Sciences, vol. 60, no. 10, 2015, pp. 3118-23.
Lua GW, Muthukaruppan R, Menon J. Can Rectal Diclofenac Prevent Post Endoscopic Retrograde Cholangiopancreatography Pancreatitis? Dig Dis Sci. 2015;60(10):3118-23.
Lua, G. W., Muthukaruppan, R., & Menon, J. (2015). Can Rectal Diclofenac Prevent Post Endoscopic Retrograde Cholangiopancreatography Pancreatitis? Digestive Diseases and Sciences, 60(10), 3118-23. https://doi.org/10.1007/s10620-015-3609-9
Lua GW, Muthukaruppan R, Menon J. Can Rectal Diclofenac Prevent Post Endoscopic Retrograde Cholangiopancreatography Pancreatitis. Dig Dis Sci. 2015;60(10):3118-23. PubMed PMID: 25757446.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Can Rectal Diclofenac Prevent Post Endoscopic Retrograde Cholangiopancreatography Pancreatitis? AU - Lua,Guan Way, AU - Muthukaruppan,Raman, AU - Menon,Jayaram, Y1 - 2015/03/11/ PY - 2015/01/19/received PY - 2015/02/21/accepted PY - 2015/3/12/entrez PY - 2015/3/12/pubmed PY - 2015/12/17/medline KW - Diclofenac sodium KW - Endoscopic retrograde cholangiopancreatography KW - Pancreatitis KW - Prevention KW - Rectal suppositories SP - 3118 EP - 23 JF - Digestive diseases and sciences JO - Dig. Dis. Sci. VL - 60 IS - 10 N2 - BACKGROUND: Non steroidal anti-inflammatory drugs (NSAIDs) have been shown to reduce the incidence of post endoscopic retrograde cholangiopancreatography pancreatitis (PEP). There were various trials using different routes and dosages of NSAIDs but meta-analysis revealed inconsistent results. AIMS: The aims of this study were to determine the efficacy of rectal diclofenac in preventing PEP and to evaluate any adverse events. METHODS: This was a randomized, open-label, two-arm, prospective clinical trial. Only patients at high risk of developing PEP were recruited. They received 100 mg rectal diclofenac or no intervention immediately after ERCP. The patients were reviewed 30 days after discharge to evaluate any adverse event. RESULTS: Among 144 recruited patients, 69 (47.9%) received diclofenac and 75 (52.1%) had no intervention. Eleven patients (7.6%) developed PEP, in which seven were from the diclofenac group and four were in the control group. Eight cases of PEP (5.5%) were mild and three cases (2.1%) were moderate. The differences in pancreatitis incidence and severity between both groups were not statistically significant. There were 11 adverse events reported. Clinically significant bleeding happened in four patients (2.8%): one from the diclofenac group and three from the control group. Other events included cholangitis: two patients (2.9%) from the diclofenac group and four (5.3%) from the control group. One patient from the diclofenac group (1.4%) had a perforation which was treated conservatively. CONCLUSIONS: In summary, prophylactic rectal diclofenac did not significantly decrease the incidence of PEP among patients at high risk for developing PEP. However, the administration of diclofenac was fairly safe with few clinical adverse events. SN - 1573-2568 UR - https://www.unboundmedicine.com/medline/citation/25757446/Can_Rectal_Diclofenac_Prevent_Post_Endoscopic_Retrograde_Cholangiopancreatography_Pancreatitis L2 - https://doi.org/10.1007/s10620-015-3609-9 DB - PRIME DP - Unbound Medicine ER -