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Diclofenac does not reduce the risk of acute pancreatitis in patients with primary sclerosing cholangitis after endoscopic retrograde cholangiography
- Source :
- United European Gastroenterol J
- Publication Year :
- 2020
- Publisher :
- Wiley, 2020.
-
Abstract
- Background The European Society of Gastrointestinal Endoscopy recommends rectal indomethacin or diclofenac before endoscopic retrograde cholangiopancreatography (ERCP) to prevent post-ERCP pancreatitis. However, data on the prophylactic effect in patients with primary sclerosing cholangitis (PSC) are lacking. Methods This was a retrospective case-control study. In 2009-2018, a total of 2000 ERCPs were performed in 931 patients with PSC. Case procedures (N = 1000 after November 2013) were performed after administration of rectal diclofenac. Control procedures (N = 1000 before November 2013) were performed with the same indication but without diclofenac. Acute post-ERCP pancreatitis and other ERCP-related adverse events (AEs) were evaluated. Results Post-ERCP pancreatitis developed in 49 (4.9%) procedures in the diclofenac group and 62 (6.2%) procedures in the control group (p = 0.241). No difference existed between the groups in terms of the severity of pancreatitis or any other acute AEs. The risk of pancreatitis was elevated in patients with native papilla: 11.4% in the diclofenac group and 8.7% in the control group (p = 0.294). In adjusted logistic regression, diclofenac did not reduce the risk of pancreatitis (odds ratio (OR) = 1.074, 95% confidence interval 0.708-1.629, p = 0.737). However, in generalised estimation equations with the advanced model, diclofenac seemed to diminish the risk of pancreatitis (OR = 0.503) but not significantly (p = 0.110). Conclusion In this large patient cohort in a low-risk unit, diclofenac does not seem to reduce the risk of post-ERCP pancreatitis in patients with PSC. The trend in the pancreatitis rate after ERCP is decreasing. The evaluation of the benefits of diclofenac among PSC patients warrants a randomised controlled study targeted to high-risk patients and procedures.
- Subjects :
- Male
post endoscopic retrograde cholangiography pancreatitis
CHOLANGIOPANCREATOGRAPHY PANCREATITIS
Gastroenterology
Postoperative Complications
0302 clinical medicine
Risk Factors
Odds Ratio
Gastrointestinal endoscopy
Cholangiopancreatography, Endoscopic Retrograde
COMPLICATIONS
Endoscopic retrograde cholangiopancreatography
medicine.diagnostic_test
Primary sclerosing cholangitis
Anti-Inflammatory Agents, Non-Steroidal
NONSTEROIDAL ANTIINFLAMMATORY DRUGS
Middle Aged
EUROPEAN-SOCIETY
3. Good health
Treatment Outcome
surgical procedures, operative
Oncology
030220 oncology & carcinogenesis
Acute pancreatitis
Female
030211 gastroenterology & hepatology
medicine.drug
Adult
medicine.medical_specialty
Diclofenac
Adolescent
Cholangitis, Sclerosing
Risk Assessment
digestive system
Young Adult
03 medical and health sciences
Administration, Rectal
Internal medicine
medicine
Humans
In patient
METAANALYSIS
Aged
Retrospective Studies
NSAIDS
business.industry
ESGE
Original Articles
3126 Surgery, anesthesiology, intensive care, radiology
medicine.disease
PREVENTION
digestive system diseases
stomatognathic diseases
POST-ERCP PANCREATITIS
Pancreatitis
3121 General medicine, internal medicine and other clinical medicine
Case-Control Studies
Feasibility Studies
Endoscopic retrograde cholangiography
RECTAL INDOMETHACIN
business
Post ercp pancreatitis
Subjects
Details
- ISSN :
- 20506414 and 20506406
- Volume :
- 8
- Database :
- OpenAIRE
- Journal :
- United European Gastroenterology Journal
- Accession number :
- edsair.doi.dedup.....f02d4a44c7fcf7a7782e4fba848b690f