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Comparison of rectal indomethacin, diclofenac, and naproxen for the prevention of post endoscopic retrograde cholangiopancreatography pancreatitis.
Eur J Gastroenterol Hepatol. 2017 Mar; 29(3):349-354.EJ

Abstract

BACKGROUND AND AIM

NSAIDs are commonly utilized for the prevention of post endoscopic retrograde cholangiopancreatography pancreatitis (PEP). However, not much is known about the most effective drug in preventing this complication. This study aims to clarify which drug (indomethacin, diclofenac, or naproxen) is most effective for the prevention of post endoscopic retrograde cholangiopancreatography (ERCP).

MATERIALS AND METHODS

In a double-blind, randomized study, patients received a single rectal dose of one of the three drugs 30 min before undergoing ERCP: diclofenac (100 mg), indomethacin (100 mg), or naproxen (500 mg). The primary outcome measured was the development of pancreatitis. The levels of serum amylase, lipase, lipoxin A4, and resolvin E1 were measured before ERCP, and at 24 h after the procedure.

RESULTS

Three hundred and seventy-two patients completed the study. The overall incidence of PEP was 8.6%, which occurred in five of the 124 (4%) patients who received diclofenac, seven of the 122 (5.8%) patients who received indomethacin, and 20 of the 126 (15.9%) patients who received naproxen. There were no significant differences in amylase and lipase levels among the three groups (P=0.183 and 0.597, respectively). Unlike patients in the naproxen group, patients in the diclofenac and indomethacin groups showed a significant increase in lipoxin A4 and resolvin E1 (P=0.001 and 0.02, respectively).

CONCLUSION

Diclofenac and indomethacin patient groups had a lower incidence of PEP than the naproxen group.

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Authors+Show Affiliations

Mohammad Alizadeh AH
aGastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases bDepartment of Clinical Pharmacy, School of Pharmacy cDepartment of Anesthesiology, Akhtar Hospital, Shahid Beheshti University of Medical Sciences dDepartment of Clinical Pharmacy, Islamic Azad University of Pharmaceutical Sciences Branch, Tehran, Iran.
Abbasinazari M
No affiliation info available
Hatami B
No affiliation info available
Abdi S
No affiliation info available
Ahmadpour F
No affiliation info available
Dabir S
No affiliation info available
Nematollahi A
No affiliation info available
Fatehi S
No affiliation info available
Pourhoseingholi MA
No affiliation info available

MeSH

Administration, RectalAdultAgedAmylasesAnti-Inflammatory Agents, Non-SteroidalBiomarkersCholangiopancreatography, Endoscopic RetrogradeDiclofenacDouble-Blind MethodEicosapentaenoic AcidFemaleHumansIncidenceIndomethacinIranLipaseLipoxinsMaleMiddle AgedNaproxenPancreatitisRisk FactorsTime FactorsTreatment Outcome

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

27849643

Citation

Mohammad Alizadeh, Amir H., et al. "Comparison of Rectal Indomethacin, Diclofenac, and Naproxen for the Prevention of Post Endoscopic Retrograde Cholangiopancreatography Pancreatitis." European Journal of Gastroenterology & Hepatology, vol. 29, no. 3, 2017, pp. 349-354.
Mohammad Alizadeh AH, Abbasinazari M, Hatami B, et al. Comparison of rectal indomethacin, diclofenac, and naproxen for the prevention of post endoscopic retrograde cholangiopancreatography pancreatitis. Eur J Gastroenterol Hepatol. 2017;29(3):349-354.
Mohammad Alizadeh, A. H., Abbasinazari, M., Hatami, B., Abdi, S., Ahmadpour, F., Dabir, S., Nematollahi, A., Fatehi, S., & Pourhoseingholi, M. A. (2017). Comparison of rectal indomethacin, diclofenac, and naproxen for the prevention of post endoscopic retrograde cholangiopancreatography pancreatitis. European Journal of Gastroenterology & Hepatology, 29(3), 349-354. https://doi.org/10.1097/MEG.0000000000000787
Mohammad Alizadeh AH, et al. Comparison of Rectal Indomethacin, Diclofenac, and Naproxen for the Prevention of Post Endoscopic Retrograde Cholangiopancreatography Pancreatitis. Eur J Gastroenterol Hepatol. 2017;29(3):349-354. PubMed PMID: 27849643.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of rectal indomethacin, diclofenac, and naproxen for the prevention of post endoscopic retrograde cholangiopancreatography pancreatitis. AU - Mohammad Alizadeh,Amir H, AU - Abbasinazari,Mohammad, AU - Hatami,Behzad, AU - Abdi,Saeed, AU - Ahmadpour,Forozan, AU - Dabir,Shideh, AU - Nematollahi,Aida, AU - Fatehi,Samira, AU - Pourhoseingholi,Mohammad A, PY - 2016/11/17/pubmed PY - 2017/8/2/medline PY - 2016/11/17/entrez SP - 349 EP - 354 JF - European journal of gastroenterology & hepatology JO - Eur J Gastroenterol Hepatol VL - 29 IS - 3 N2 - BACKGROUND AND AIM: NSAIDs are commonly utilized for the prevention of post endoscopic retrograde cholangiopancreatography pancreatitis (PEP). However, not much is known about the most effective drug in preventing this complication. This study aims to clarify which drug (indomethacin, diclofenac, or naproxen) is most effective for the prevention of post endoscopic retrograde cholangiopancreatography (ERCP). MATERIALS AND METHODS: In a double-blind, randomized study, patients received a single rectal dose of one of the three drugs 30 min before undergoing ERCP: diclofenac (100 mg), indomethacin (100 mg), or naproxen (500 mg). The primary outcome measured was the development of pancreatitis. The levels of serum amylase, lipase, lipoxin A4, and resolvin E1 were measured before ERCP, and at 24 h after the procedure. RESULTS: Three hundred and seventy-two patients completed the study. The overall incidence of PEP was 8.6%, which occurred in five of the 124 (4%) patients who received diclofenac, seven of the 122 (5.8%) patients who received indomethacin, and 20 of the 126 (15.9%) patients who received naproxen. There were no significant differences in amylase and lipase levels among the three groups (P=0.183 and 0.597, respectively). Unlike patients in the naproxen group, patients in the diclofenac and indomethacin groups showed a significant increase in lipoxin A4 and resolvin E1 (P=0.001 and 0.02, respectively). CONCLUSION: Diclofenac and indomethacin patient groups had a lower incidence of PEP than the naproxen group. SN - 1473-5687 UR - https://www.unboundmedicine.com/medline/citation/27849643/Comparison_of_rectal_indomethacin_diclofenac_and_naproxen_for_the_prevention_of_post_endoscopic_retrograde_cholangiopancreatography_pancreatitis_ L2 - http://dx.doi.org/10.1097/MEG.0000000000000787 DB - PRIME DP - Unbound Medicine ER -