Optimal timing of rectal diclofenac in preventing post-endoscopic retrograde cholangiopancreatography pancreatitis

Christina J. Sperna Weiland; Xavier J.N.M. Smeets; Robert C. Verdonk; Alexander C. Poen; Abha Bhalla; Niels G. Venneman; Wietske Kievit; Hester C. Timmerhuis; Devica S. Umans; Jeanin E. van Hooft; Marc G. Besselink; Hjalmar C. van Santvoort; Paul Fockens; Marco J. Bruno; Joost P.H. Drenth; Erwin J.M. van Geenen; on behalf of the Dutch Pancreatitis Study Group

doi:10.1055/a-1675-2108

Endoscopy International Open, Table of Contents

CC BY-NC-ND 4.0 · Endoscopy 2022; 10(03): E246-E253
DOI: 10.1055/a-1675-2108

Original article

Optimal timing of rectal diclofenac in preventing post-endoscopic retrograde cholangiopancreatography pancreatitis

Christina J. Sperna Weiland

¹Department of Gastroenterology and Hepatology, Radboud Institute for Molecular Life Science, Radboudumc, Nijmegen, the Netherlands

²Department of Research and Development, St. Antonius Hospital, Nieuwegein, the Netherlands

,

Xavier J.N.M. Smeets

³Department of Gastroenterology and Hepatology, Jeroen Bosch ziekenhuis, Den Bosch, the Netherlands

,

Robert C. Verdonk

⁴Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, the Netherlands

,

Alexander C. Poen

⁵Department of Gastroenterology and Hepatology, Isala Clinics, Zwolle, the Netherlands

,

Abha Bhalla

⁶Department of Gastroenterology and Hepatology, Hagaziekenhuis, The Hague, the Netherlands

,

Niels G. Venneman

⁷Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede, the Netherlands

,

Wietske Kievit

⁸Department for Health evidence, Radboudumc, Nijmegen, the Netherlands

,

Hester C. Timmerhuis

²Department of Research and Development, St. Antonius Hospital, Nieuwegein, the Netherlands

,

Devica S. Umans

²Department of Research and Development, St. Antonius Hospital, Nieuwegein, the Netherlands

⁹Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, Amsterdam, the Netherlands

,

Jeanin E. van Hooft

¹⁰Department of Gastroenterology and Hepatology, Leiden University medical Centre, Leiden, the Netherlands

,

Marc G. Besselink

¹¹Department of Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, Amsterdam, the Netherlands

,

Hjalmar C. van Santvoort

¹²Department of Surgery, St Antonius Hospital, Nieuwegein, the Netherlands

¹³Department of Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands

,

Paul Fockens

⁹Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, Amsterdam, the Netherlands

,

Marco J. Bruno

¹⁴Department of Gastroenterology and Hepatology, Erasmus Medical Centre, Rotterdam, the Netherlands

,

Joost P.H. Drenth

¹Department of Gastroenterology and Hepatology, Radboud Institute for Molecular Life Science, Radboudumc, Nijmegen, the Netherlands

,

Erwin J.M. van Geenen

¹Department of Gastroenterology and Hepatology, Radboud Institute for Molecular Life Science, Radboudumc, Nijmegen, the Netherlands

,

on behalf of the Dutch Pancreatitis Study Group

› Author Affiliations

Abstract

Background and study aims Rectal nonsteroidal anti-inflammatory drug (NSAID) prophylaxis reduces incidence of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. Direct comparisons to the optimal timing of administration, before or after ERCP, are lacking. Therefore, we aimed to assess whether timing of rectal NSAID prophylaxis affects the incidence of post-ERCP pancreatitis.

Patients and methods We conducted an analysis of prospectively collected data from a randomized clinical trial. We included patients with a moderate to high risk of developing post-ERCP pancreatitis, all of whom received rectal diclofenac monotherapy 100-mg prophylaxis. Administration was within 30 minutes before or after the ERCP at the discretion of the endoscopist. The primary endpoint was post-ERCP pancreatitis. Secondary endpoints included severity of pancreatitis, length of hospitalization, and Intensive Care Unit (ICU) admittance.

Results We included 346 patients who received the rectal NSAID before ERCP and 63 patients who received it after ERCP. No differences in baseline characteristics were observed. Post-ERCP pancreatitis incidence was lower in the group that received pre-procedure rectal NSAIDs (8 %), compared to post-procedure (18 %) (relative risk: 2.32; 95% confidence interval: 1.21 to 4.46, P = 0.02). Hospital stays were significantly longer with post-procedure prophylaxis (1 day; interquartile range [IQR] 1–2 days vs. 1 day; IQR 1–4 days; P = 0.02). Patients from the post-procedure group were more likely to be admitted to the ICU (1 patient [0.3 %] vs. 4 patients [6 %]; P = 0.002).

Conclusions Pre-procedure administration of rectal diclofenac is associated with a significant reduction in post-ERCP pancreatitis incidence compared to post-procedure use.

Full Text

References

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Supplementary Material

Supplementary material