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CC BY-NC-ND 4.0 · Endosc Int Open 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
 1   Department of Gastroenterology and Hepatology, Radboud Institute for Molecular Life Science, Radboudumc, Nijmegen, the Netherlands
 2   Department of Research and Development, St. Antonius Hospital, Nieuwegein, the Netherlands
,
Xavier J.N.M. Smeets
 3   Department of Gastroenterology and Hepatology, Jeroen Bosch ziekenhuis, Den Bosch, the Netherlands
,
Robert C. Verdonk
 4   Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, the Netherlands
,
Alexander C. Poen
 5   Department of Gastroenterology and Hepatology, Isala Clinics, Zwolle, the Netherlands
,
Abha Bhalla
 6   Department of Gastroenterology and Hepatology, Hagaziekenhuis, The Hague, the Netherlands
,
Niels G. Venneman
 7   Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede, the Netherlands
,
Wietske Kievit
 8   Department for Health evidence, Radboudumc, Nijmegen, the Netherlands
,
Hester C. Timmerhuis
 2   Department of Research and Development, St. Antonius Hospital, Nieuwegein, the Netherlands
,
Devica S. Umans
 2   Department of Research and Development, St. Antonius Hospital, Nieuwegein, the Netherlands
 9   Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, Amsterdam, the Netherlands
,
Jeanin E. van Hooft
10   Department of Gastroenterology and Hepatology, Leiden University medical Centre, Leiden, the Netherlands
,
Marc G. Besselink
11   Department of Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, Amsterdam, the Netherlands
,
Hjalmar C. van Santvoort
12   Department of Surgery, St Antonius Hospital, Nieuwegein, the Netherlands 
13   Department of Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands
,
Paul Fockens
 9   Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, Amsterdam, the Netherlands
,
Marco J. Bruno
14   Department of Gastroenterology and Hepatology, Erasmus Medical Centre, Rotterdam, the Netherlands
,
Joost P.H. Drenth
 1   Department of Gastroenterology and Hepatology, Radboud Institute for Molecular Life Science, Radboudumc, Nijmegen, the Netherlands
,
Erwin J.M. van Geenen
 1   Department of Gastroenterology and Hepatology, Radboud Institute for Molecular Life Science, Radboudumc, Nijmegen, the Netherlands
,
on behalf of the Dutch Pancreatitis Study Group › Author AffiliationsSupported by: ZonMw 837001506
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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.

Supplementary material



Publication History

Received: 30 May 2021

Accepted: 21 September 2021

Article published online:
14 March 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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Comment to this article:

Endoscopy International Open – recently publishedEndoscopy 2022; 54(04): 436-436
DOI: 10.1055/a-1725-3812

 

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