Rectal NSAIDs to Prevent Post-ERCP Pancreatitis
Rectal NSAIDs to Prevent Post-ERCP Pancreatitis
Elmunzer BJ, Scheiman JM, Lehman GA, et al; U.S. Cooperative for Outcomes Research in Endoscopy (USCORE)
N Engl J Med. 2012;366:1414-1422
Can the frequency of pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP) be reduced by immediate administration of an anti-inflammatory agent after the procedure? The authors of this multicenter study performed a randomized trial involving 602 patients undergoing ERCP.
Of those who received rectal indomethacin immediately after ERCP, 9.2% developed pancreatitis, compared with 16.9% of patients who received placebo (P = .005). When pancreatitis did occur, it was milder in the indomethacin group (P = .03). Adverse effects were less common in the indomethacin group, and hospital length of stay was shorter by half a day (P ≤ .001).
Indomethacin effectively lowered the rate of post-ERCP pancreatitis and seemed to have a beneficial effect on the course of pancreatitis when it did develop. The observed rate of pancreatitis in the control group (16.9%) was much higher than the 10% that was observed during the planning phases of the study. This is somewhat surprising, but as the investigators suggested, it may be explained by more careful postoperative patient monitoring in the setting of a randomized controlled trial.
Abstract
A Randomized Trial of Rectal Indomethacin to Prevent Post-ERCP Pancreatitis
Elmunzer BJ, Scheiman JM, Lehman GA, et al; U.S. Cooperative for Outcomes Research in Endoscopy (USCORE)
N Engl J Med. 2012;366:1414-1422
Summary
Can the frequency of pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP) be reduced by immediate administration of an anti-inflammatory agent after the procedure? The authors of this multicenter study performed a randomized trial involving 602 patients undergoing ERCP.
Of those who received rectal indomethacin immediately after ERCP, 9.2% developed pancreatitis, compared with 16.9% of patients who received placebo (P = .005). When pancreatitis did occur, it was milder in the indomethacin group (P = .03). Adverse effects were less common in the indomethacin group, and hospital length of stay was shorter by half a day (P ≤ .001).
Viewpoint
Indomethacin effectively lowered the rate of post-ERCP pancreatitis and seemed to have a beneficial effect on the course of pancreatitis when it did develop. The observed rate of pancreatitis in the control group (16.9%) was much higher than the 10% that was observed during the planning phases of the study. This is somewhat surprising, but as the investigators suggested, it may be explained by more careful postoperative patient monitoring in the setting of a randomized controlled trial.
Abstract
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