Rectal Diclofenac administration for prevention of post-Endoscopic Retrograde Cholangio-Pancreatography (ERCP) acute
G Geraci1, V D Palumbo1, B D'Orazio1
1University Teaching Hospital "Paolo Giaccone" of Palermo, Section of General and Thoracic Surgery, Palermo, Italy.
Insights
Rectal diclofenac effectively prevents post-ERCP pancreatitis (PEP). A 100 mg rectal dose administered before the procedure significantly reduced PEP incidence and severity compared to other methods.
Area of Science:
- Gastroenterology
- Endoscopy
- Pharmacology
Background:
- Post-Endoscopic Retrograde Cholangio-Pancreatography pancreatitis (PEP) is a significant complication of biliopancreatic endoscopy.
- Nonsteroidal anti-inflammatory drugs, particularly rectal diclofenac, show potential for PEP prophylaxis.
Purpose of the Study:
- To evaluate the efficacy of prophylactic oral, rectal suppository, and intramuscular diclofenac versus placebo in reducing the incidence and severity of ERCP-induced pancreatitis.
Main Methods:
- A randomized, double-blinded, prospective study involving 100 patients undergoing ERCP.
- Patients were allocated to five groups: placebo, oral diclofenac, rectal diclofenac (100 mg), intramuscular diclofenac, and intravenous diclofenac.
- Diclofenac was administered 30-90 minutes prior to ERCP, with clinical data collected pre-procedure and at 2, 12, and 24 hours post-ERCP.
Main Results:
- The incidence of PEP was significantly lower in the rectal diclofenac group compared to all other groups (p < 0.001).
- Post-ERCP pain incidence was also significantly reduced in the rectal diclofenac group (p = 0.001).
- Patients receiving rectal diclofenac experienced earlier discharge (p < 0.01).
Conclusions:
- A 100 mg dose of rectal diclofenac administered 30-60 minutes before ERCP is an effective method for preventing PEP.
- Rectal diclofenac demonstrates superior efficacy in PEP prevention compared to oral, intramuscular, and intravenous routes.
Introduction:
Post-Endoscopic Retrograde Cholangio-Pancreatography pancreatitis (PEP) is a relevant (1-4%) complication of biliopancreatic operative endoscopy. Rectal nonsteroidal anti-inflammatory drugs (specifically, 100 mg of diclofenac) have shown promising prophylactic activity in PEP. The aim of our prospective study is to report whether prophylactic oral versus rectal suppository versus intramuscular diclofenac versus placebo are able to reduce the incidence and the severity of ERCP-induced pancreatitis.
Materials And Methods:
In this randomized, double-blinded, prospective study, 100 patients (49 male, 51 female), similar with regard to indication for ERCP, were enrolled between January 2016 and November 2017 to undergo ERCP in the Section of General and Thoracic Surgery of University Hospital of Palermo. They were randomized into five groups, respectively 20 patients with placebo by mouth; 20 patients with 50 mg diclofenac sodium enteric-coated capsules by mouth; 20 with 100 mg rectal suppository diclofenac, 20 with 75 mg/3 ml intramuscular diclofenac sodium, 20 with 75 mg/3 ml intramuscular diclofenac sodium and 20 with 75 mg/3 ml intravenous diclofenac. All drugs were administered 30 to 90 minutes before ERCP. All clinical data were collected one day before and 2, 12 and 24 hour after ERCP.
Result:
Data were prospectively collected and to demonstrate the preventive effect of rectal diclofenac on PEP, a two-by-two table and chi-square test with Yates correction were used: the incidence of PEP was significantly lower (p < 0.001) in the rectal diclofenac group respect to other groups and, in the same way, the incidence of post-ERCP pain was significantly lower in the rectal diclofenac group than in the other groups (p = 0.001) and patients discharge was consequently earlier (p < 0.01).
Conclusion:
100 mg dose rectal diclofenac administered 30-60 minutes before ERCP can effectively prevent PEP.
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