Pancreatic duct stent and NSAIDs for prevention of post ERCP pancreatitis in choledocholithiasis patients: a prospective randomized controlled study / 中华消化内镜杂志

ABSTRACT

Objective To evaluate the prophylactic effect of pancreatic duct stent (PPDS),NonSteroid Anti-Inflammtory Drugs (NSAIDs),and joint PPDS and NSAIDs on post endoscopic rectrograde cholangiopancreatography(ERCP) Pancreatitis(PEP) in choledocholithiasis patients.Methods A total of 200 choledocholithiasis patients were randomly divided into 4 groups,prophylactic pancreatic duct stent(PPDS) group (A),NSAIDs group (B),joint PPDS-NSAIDs group (C) and routine ERCP without prevention for PEP(group D).VAS score,levels of amylase in serum and CRP were measured before and 4 h,24 h,48 h after ERCP.Incidences of hyperamylasemia and PEP were observed.Results (1) Incidences of hyperamylasemia 48 h after ERCP were 6％ (3/50),6％ (3/50) and 4％ (2/50) in group A,group B and group C respectively,which were significantly lower than that of group D (11/55) (P ＜ 0.05).(2) Incidences of PEP 48 h after ERCP were both 2％ (1/50) in group A and group C,which were lower than that in group D (10％,5/50,P ＜ 0.05).Group B (4％,2/50) was lower than that of group D but there was no statistical significance(P ＞0.05).(3) VAS scores of all groups at 4 h,24 h and 48 h after the operation were significantly higher than before (P ＜ 0.05).Group B score was significantly lower than that of group D (P ＜ 0.05).Scores of group A and C at 4 h were lower than those of group D (P ＜ 0.05),and those at 24 h and 48 h were also lower but with no statistical significance (P ＞ 0.05).(4) Serum CRP levels at 4 h,24 h and 48 h were significantly higher than those before in each group.Serum CRP levels of group B and C were significantly lower than that of group D at 4 h,24 h and 48 h.Serum CRP level of group A was significantly lower than group D at 4 h,24 h.CRP level at 48 h of group A was lower than that of group D,but there was no statistical significance (P ＞ 0.05).Conclusion Both prophylactic pancreatic duct stent and NSAIDs (Parecoxib Sodium) can reduce incidence of hyperamylasemia after ERCP common bile duct lithotomy.Single or joint use of prophylactic pancreatic duct stent can prevent PEP.Furthermore,prophylactic pancreatic duct stent and NSAIDs (Parecoxib Sodium) can reduce pain and inflammation after ERCP common bile duct lithotomy.NSAIDs only (Parecoxib Sodium) is more effective than prophylactic pancreatic duct stent only and joint use of both.