Efficacy of rectally administered indomethacin for the prevention of post ERCP pancreatitis / 中华胰腺病杂志

ABSTRACT

Objectives To evaluate the efficacy of rectally administered indomethacin for the prevention of post-ERCP pancreatitis(PEP).Methods All eligible patients without high risk factors such as heart,lung,liver and kidney,coagulation dysfunction,without malignant disease and contraindication for NSAIDs,and pre-operative imaging study and lab test suggesting no pancreatitis,aged from 18 ～ 75 who underwent ERCP and EST were enrolled.In a randomized prospective trial,patients were randomized to receive a suppository containing indomethacin,100 mg,or an identical placebo 30 minutes after ERCP.PEP was diagnosed when there was pancreatitis related clinical symptoms,and serum amylase was higher than 3 times of the normal values,and when the patient needed more than 1 day hospitalization.Patients with PEP were evaluated with APACHE Ⅱ score 72 hours after ERCP.Results During 2004 ～ 2010,a total of 348 patients were enrolled,of which 182 received indomethacin and 166 received placebo.Six patients developed pancreatitis in the indomethacin group and 14 in the placebo group (3.3％ vs.8.4％,P ＜0.05),and the difference between the two group was statistically significant ( P ＜ 0.05 ).In those patients with PEP,the APACHE Ⅱ scores in indomethacin group (4.3 ± 1.3 ) were lower than that in the placebo group (7.4 ±1.7),and the difference between the two groups was statistically significant ( P ＜ 0.05 ).The incidence of hyperamylasemia in both groups was not statistically significant (9.3％ vs.10.8％,P ＞ 0.05 ).Conclusions This trial shows that rectally administered indomethacin after ERCP and EST can effectively reduce the incidence and severity of PEP.