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Does rectal diclofenac reduce post-ERCP pancreatitis? A district general hospital experience
Giovanna Sheiybani1, Peter Brydon1, Miriam Toolan1
1Gastroenterology, Royal United Hospital, Bath, UK.
Frontline Gastroenterology
|February 28, 2018
Summary
Rectal non-steroidal anti-inflammatory drugs (NSAID) significantly reduce the risk of post-ERCP pancreatitis (PEP). Routine or selective NSAID use in high-risk patients lowered PEP incidence by 43.7% in this study.
Area of Science:
- Gastroenterology
- Clinical Pharmacology
Background:
- Controversy exists regarding the efficacy of rectal NSAIDs in preventing post-ERCP pancreatitis (PEP).
- This study evaluated PEP incidence across different rectal diclofenac administration strategies.
Purpose of the Study:
- To compare PEP incidence in patients receiving no rectal diclofenac, selective use, or routine use.
- To assess the impact of NSAID administration protocols on PEP rates.
Main Methods:
- Retrospective analysis of 1318 ERCP procedures from August 2010 to December 2015.
- Data sources included readmission records, blood results, radiology reports, and discharge summaries.
- Rectal diclofenac administration was recorded via the endoscopy reporting system.
Main Results:
- Overall PEP incidence was 5.0% (66/1318).
- PEP rates were 7.9% (35/445) before NSAID use, 3.2% (17/539) during selective use, and 3.9% (13/334) during routine use.
- NSAID use (selective or routine) showed a statistically significant decrease in PEP compared to no NSAID use (p<0.0172).
Conclusions:
- Introduction of selective or routine rectal NSAID use significantly decreases PEP risk.
- A risk reduction of 43.7% was observed with NSAID implementation in a District General Hospital setting.
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