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Rectal Diclofenac administration for prevention of post-Endoscopic Retrograde Cholangio-Pancreatography (ERCP) acute pancreatitis. Randomized prospective study.
Clin Ter. 2019 Sep-Oct; 170(5):e332-e336.CT

Abstract

INTRODUCTION

Post-Endoscopic Retrograde Cholangio-Pancreatography pancreatitis (PEP) is a relevant (1-4%) complication of biliopancreatic operative endoscopy. Rectal nonsteroidal anti-inflammatory drugs (specifically, 100 mg of diclofenac) have shown promising prophylactic activity in PEP. The aim of our prospective study is to report whether prophylactic oral versus rectal suppository versus intramuscular diclofenac versus placebo are able to reduce the incidence and the severity of ERCP-induced pancreatitis.

MATERIALS AND METHODS

In this randomized, double-blinded, prospective study, 100 patients (49 male, 51 female), similar with regard to indication for ERCP, were enrolled between January 2016 and November 2017 to undergo ERCP in the Section of General and Thoracic Surgery of University Hospital of Palermo. They were randomized into five groups, respectively 20 patients with placebo by mouth; 20 patients with 50 mg diclofenac sodium enteric-coated capsules by mouth; 20 with 100 mg rectal suppository diclofenac, 20 with 75 mg/3 ml intramuscular diclofenac sodium, 20 with 75 mg/3 ml intramuscular diclofenac sodium and 20 with 75 mg/3 ml intravenous diclofenac. All drugs were administered 30 to 90 minutes before ERCP. All clinical data were collected one day before and 2, 12 and 24 hour after ERCP.

RESULT

Data were prospectively collected and to demonstrate the preventive effect of rectal diclofenac on PEP, a two-by-two table and chi-square test with Yates correction were used: the incidence of PEP was significantly lower (p < 0.001) in the rectal diclofenac group respect to other groups and, in the same way, the incidence of post-ERCP pain was significantly lower in the rectal diclofenac group than in the other groups (p = 0.001) and patients discharge was consequently earlier (p < 0.01).

CONCLUSION

100 mg dose rectal diclofenac administered 30-60 minutes before ERCP can effectively prevent PEP.

Authors+Show Affiliations

University Teaching Hospital "Paolo Giaccone" of Palermo, Section of General and Thoracic Surgery, Palermo, Italy.University Teaching Hospital "Paolo Giaccone" of Palermo, Section of General and Thoracic Surgery, Palermo, Italy.University Teaching Hospital "Paolo Giaccone" of Palermo, Section of General and Thoracic Surgery, Palermo, Italy.University Teaching Hospital "Paolo Giaccone" of Palermo, Section of General and Thoracic Surgery, Palermo, Italy.University Teaching Hospital "Paolo Giaccone" of Palermo, Section of General and Thoracic Surgery, Palermo, Italy.University Teaching Hospital "Paolo Giaccone" of Palermo, Section of General and Thoracic Surgery, Palermo, Italy.

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

31612188

Citation

Geraci, G, et al. "Rectal Diclofenac Administration for Prevention of post-Endoscopic Retrograde Cholangio-Pancreatography (ERCP) Acute Pancreatitis. Randomized Prospective Study." La Clinica Terapeutica, vol. 170, no. 5, 2019, pp. e332-e336.
Geraci G, Palumbo VD, D'Orazio B, et al. Rectal Diclofenac administration for prevention of post-Endoscopic Retrograde Cholangio-Pancreatography (ERCP) acute pancreatitis. Randomized prospective study. Clin Ter. 2019;170(5):e332-e336.
Geraci, G., Palumbo, V. D., D'Orazio, B., Maffongelli, A., Fazzotta, S., & Lo Monte, A. I. (2019). Rectal Diclofenac administration for prevention of post-Endoscopic Retrograde Cholangio-Pancreatography (ERCP) acute pancreatitis. Randomized prospective study. La Clinica Terapeutica, 170(5), e332-e336. https://doi.org/10.7417/CT.2019.2156
Geraci G, et al. Rectal Diclofenac Administration for Prevention of post-Endoscopic Retrograde Cholangio-Pancreatography (ERCP) Acute Pancreatitis. Randomized Prospective Study. Clin Ter. 2019 Sep-Oct;170(5):e332-e336. PubMed PMID: 31612188.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Rectal Diclofenac administration for prevention of post-Endoscopic Retrograde Cholangio-Pancreatography (ERCP) acute pancreatitis. Randomized prospective study. AU - Geraci,G, AU - Palumbo,V D, AU - D'Orazio,B, AU - Maffongelli,A, AU - Fazzotta,S, AU - Lo Monte,A I, PY - 2019/10/16/entrez PY - 2019/10/16/pubmed PY - 2019/12/28/medline KW - Complication KW - Diclofenac KW - ERCP KW - Pancreatitis KW - Prevention SP - e332 EP - e336 JF - La Clinica terapeutica JO - Clin Ter VL - 170 IS - 5 N2 - INTRODUCTION: Post-Endoscopic Retrograde Cholangio-Pancreatography pancreatitis (PEP) is a relevant (1-4%) complication of biliopancreatic operative endoscopy. Rectal nonsteroidal anti-inflammatory drugs (specifically, 100 mg of diclofenac) have shown promising prophylactic activity in PEP. The aim of our prospective study is to report whether prophylactic oral versus rectal suppository versus intramuscular diclofenac versus placebo are able to reduce the incidence and the severity of ERCP-induced pancreatitis. MATERIALS AND METHODS: In this randomized, double-blinded, prospective study, 100 patients (49 male, 51 female), similar with regard to indication for ERCP, were enrolled between January 2016 and November 2017 to undergo ERCP in the Section of General and Thoracic Surgery of University Hospital of Palermo. They were randomized into five groups, respectively 20 patients with placebo by mouth; 20 patients with 50 mg diclofenac sodium enteric-coated capsules by mouth; 20 with 100 mg rectal suppository diclofenac, 20 with 75 mg/3 ml intramuscular diclofenac sodium, 20 with 75 mg/3 ml intramuscular diclofenac sodium and 20 with 75 mg/3 ml intravenous diclofenac. All drugs were administered 30 to 90 minutes before ERCP. All clinical data were collected one day before and 2, 12 and 24 hour after ERCP. RESULT: Data were prospectively collected and to demonstrate the preventive effect of rectal diclofenac on PEP, a two-by-two table and chi-square test with Yates correction were used: the incidence of PEP was significantly lower (p < 0.001) in the rectal diclofenac group respect to other groups and, in the same way, the incidence of post-ERCP pain was significantly lower in the rectal diclofenac group than in the other groups (p = 0.001) and patients discharge was consequently earlier (p < 0.01). CONCLUSION: 100 mg dose rectal diclofenac administered 30-60 minutes before ERCP can effectively prevent PEP. SN - 1972-6007 UR - https://www.unboundmedicine.com/medline/citation/31612188/Rectal_Diclofenac_administration_for_prevention_of_post_Endoscopic_Retrograde_Cholangio_Pancreatography__ERCP__acute_pancreatitis__Randomized_prospective_study_ L2 - http://www.clinicaterapeutica.it/ojs/index.php/ClinicaTerapeutica/article/view/482/187 DB - PRIME DP - Unbound Medicine ER -