Combined rectal indomethacin and intravenous saline hydration in post-ERCP pancreatitis prophylaxis |
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| Affiliation: | 1. Endemic Medicine Department, Faculty of Medicine, Cairo University, Egypt;2. Police Hospital, Giza, Egypt;3. Clinical Pathology Department, Faculty of Medicine, Cairo University, Egypt;1. Division of Gastroenterology, Bezmialem Vakif University, Istanbul, Turkey;2. Division of Internal Medicine, Bezmialem Vakif University, Istanbul, Turkey;3. Bezmialem Vakif University School of Medicine, Istanbul, Turkey;1. Department of General Surgery, Cerrahpasa Medical Faculty, ?stanbul University- Cerrahpasa, ?stanbul, Turkey;2. Department of Pathology, Cerrahpasa Medical Faculty, ?stanbul University- Cerrahpasa, ?stanbul, Turkey;1. Endemic Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt;2. Department of Microbial Biotechnology, Biotechnology Research Institute, National Research Centre, Giza, Egypt;3. Department of Pharmacy, Al-Mustaqbal University College, Babylon, Iraq;4. Clinical Pharmacy unit, Badr University Hospital, Helwan University, Egypt;1. Hepatology and Gastroenterology Department, National Liver Institute, Menoufia University, Egypt;2. Department of Internal Medicine, Salem Medical Center and Center for Alcohol Research and Liver Disease, University of Heidelberg, Germany;3. Endemic Medicine and Hepato-gastroenterology Department, Faculty of Medicine, Cairo University, Cairo, Egypt;4. Gynecology and Obstetrics Department, Faculty of Medicine, Cairo University, Cairo, Egypt;1. Department of Gastroenterology, Osaka City University Graduate School of Medicine, Japan;2. Department of Nursing, Osaka City University Hospital, Japan |
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| Abstract: | Background and study aimAcute pancreatitis (AP) is a potentially life-threatening complication of endoscopic retrograde cholangiopancreatography (ERCP). There is a lack of effective measures to prevent post-ERCP pancreatitis (PEP), except NSAIDs. Aggressive hydration for AP can be considered, given the frequency of hemoconcentration, hypovolemia, and hypoperfusion in pancreatitis. We aimed to clarify the clinical utility of combined indomethacin and saline hydration for preventing PEP.Patients and methodIn this cross-sectional study, 120 patients undergoing ERCP for the first time at the Gastrointestinal Endoscopy Unit and Liver Unit Kasralainy (GIELUKA) were enrolled and then randomly allocated into two groups: indomethacin and indomethacin-hydration groups. Intravenous (IV) saline was given to the latter at a rate of 10 ml/kg/h after the ERCP for 2 h.ResultsThe age of the studied patients was 43.8 ± 14.9 years, with 55% of them being female. The patient-related risk factors for PEP were older age (p = 0.039), higher pre-ERCP urea level (p = 0.032), and less choledocholithiasis (p = 0.028). The patients with PEP had a higher frequency of biliary cannulation attempts (p = 0.004) and accidental pancreatic duct cannulation (p = 0.003), required a longer cannulation time (p = 0.021), had undergone precut knife and transpancreatic sphincterotomy at a higher rate (p = 0.032; and p = 0.001, respectively), and had a significantly longer procedure time (p = 0.006).PEP occurred in only five patients in the indomethacin group, while it did not occur in the indomethacin-hydration group (8% vs. 0%, p = 0.022). Serum amylase and lipase elevation 2 h after ERCP were predictors of PEP. However, serum amylase only was significantly lower 2 h post-ERCP in the indomethacin-hydration group than in the indomethacin group (p = 0.045). Moreover, abdominal pain and vomiting on the first day of ERCP were good predictors of PEP.ConclusionAggressive IV saline hydration with rectal indomethacin can more effectively prevent PEP than indomethacin alone. |
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| Keywords: | ERCP Pancreatitis Hydration Saline Indomethacin |
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