Efficacy and safety of rectal indomethacin suppositories in reducing incidence of post-endoscopic retrograde cholangiopancreatography pancreatitis(PEP) among high-risk patients
YANG Hongqi,HONG Lili,GUO YAN Fang,PENG Hui,KE Youli ZHANG Xuelan, SHI Junchao,and CAO Jifan
Department of Gastroenterology,Anhui Provincial Corps Hospital of Chinese People’s Armed Police Force,Hefei 230041,China
Abstract：Objective To evaluate the efficacy of rectal administration of indomethacin in reducing the incidence of post-ERCP pancreatitis among high-risk patients.Methods From March 2015 to November 2017,a total of 293 patients at high risk of PEP were randomly divided into the observation group(146) and the control group(147). Both groups received rectal indomethacin and placebo respectively 30 minutes before ERCP.The incidences of PEP and hyperamylasemia were compared between the two groups.Results The incidence of PEP was 4.11%(6/146)in the indomethacin group and 18.37%(27/147) in the placebo group(P<0.01).There was one case of severe pancreatitis among the six cases of PEP in the observation group and six cases of severe pancreatitis among the twenty-seven cases of PEP in the control group,respectively.On the basis of these results,it was calculated that the absolute risk was reduced by 14%,while the relative risk was reduced by 78%.There was significant difference in serum amylase levels and the incidence of hyperamylasemia between the two groups 24h after ERCP(P<0.01).Conclusions Rectal administration of indomethacin can significantly reduce the risk of PEP among high-risk patients.
杨红旗,洪丽莉,郭艳芳,彭辉,柯有利,张学兰,施俊超,曹济凡. 吲哚美辛栓纳肛降低高风险患者ERCP术后胰腺炎发生率的效果[J]. 武警医学, 2018, 29(12): 1113-1116.
YANG Hongqi,HONG Lili,GUO YAN Fang,PENG Hui,KE Youli ZHANG Xuelan, SHI Junchao,and CAO Jifan. Efficacy and safety of rectal indomethacin suppositories in reducing incidence of post-endoscopic retrograde cholangiopancreatography pancreatitis(PEP) among high-risk patients. Med. J. Chin. Peop. Armed Poli. Forc., 2018, 29(12): 1113-1116.
Freeman M L, Guda N M. Prevention of post-ERCP pancreatitis: a comprehensive review[J].Gastrointestinal endoscopy,2004,59(7):845-864.
[2]
Tenner S, Baillie J, DeWitt J, et al. American College of Gastroenterology Guideline:Management of Acute Pancreatitis[J].AMJ Gastroenterol,2013,108(9):14100-14115.
[3]
Andrade D. Rectal indomethacin versus placebo to reduce the incidence of pancreatitis after endoscopic retrograde Cholangiopancreatography: results of a controlled clinical trial[J].BMC Gastroenterology,2015,21(15):85.
[4]
Lua G W, Muthukaruppan R, Menon J. Can Rectal Diclofenac Prevent Post Endoscopic Retrograde Cholangiopancreatography Pancreatitis[J].Digestive Diseases and Sciences,2018,60(10):3118-3123.
[5]
Ding X, Chen M, Huang S,et al. Nonsteroidal anti-infammatory drugs for prevention of post-ERCP pancreatitis:a meta-analysis[J].Gastrointestinal Endoscopy,2012,76(6):1152-1159.
[6]
Luo H,Zhao L,Leung J,et al. Routine pre-procedural rectal indometacin versus selective post-procedural rectal indometacin to prevent pancreatitis in patients undergoing endoscopic retrograde cholangiopancreatography:a multicentre, single-blinded,randomised controlled trial[J].Lancet,2016,387(10035):2293-2301.
[7]
Inamdar S, Han D, Passi M,et al. Rectal indomethacin is protective against post-ERCP pancreatitis in high-risk patients but not average-risk patients: a systematic review and meta-analysis[J].Gastrointes Endosc,2017,85(1):67-75.
[8]
Dumonceau J M,Andriulli A,Elmunzer B J,et al.Prophylaxis of post-ERCP pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Guideline[J].Enndoscopy,2014,46(9):799-815.
[9]
Lankisch P G. Indomethacin may reduce the incidence and severity of acute pancreatitis afer ERCP[J].Am J Gastroenterol,2008,103(1):244.
[10]
Sun HL, Han B, Zhai HP,et al. Rectal NSAIDs for the prevention of post-ERCP pancreatitis:a meta-analysis of randomized controlled trials[J].Surgeon, 2014:12(3):141-147.
2018, Vol. 29 
