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KMID : 1048120230120020087
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International Journal of Gastrointestinal Intervention
2023 Volume.12 No. 2 p.87 ~ p.92
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The role of rectal diclofenac and aggressive hydration with Ringer’s lactate in preventing post-endoscopic retrograde cholangiopancreatography pancreatitis in high-risk patients
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Vivek Mohan Sharma
Amit Mathur
Mohan Babu Goyal
Shankar Lal Jat
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Abstract
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Background : Post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) is a common complication of therapeutic endoscopy. The aim of this trial was to determine whether a combination of rectal diclofenac and vigorous hydration with Ringer’s lactate is superior to the corresponding individual treatments for preventing PEP in high-risk patients.
Methods : This randomized, open-label, controlled trial was conducted from August 2020 to January 2022. We included patients who were at high risk of developing PEP. Three intervention groups were made: group A, diclofenac sodium suppository (100 mg); group B, aggressive hydration with Ringer’s lactate; group C, a combination of diclofenac and aggressive hydration. PEP was defined as a serum amylase level > 3 times the upper limit of normal with epigastric pain within 24 hours after endoscopic retrograde cholangiopancreatography.
Results : A total of 144 patients were included and 48 cases were randomized to each intervention group. The incidence of PEP was 8.3%, 10.4%, and 8.3% in groups A, B, and C, respectively. A personal history of alcohol consumption and more than one pancreatic duct guidewire cannulation were significantly associated with the development of PEP.
Conclusion : No difference in the incidence of PEP was observed with or without the use of aggressive hydration. Combining aggressive hydration with a rectal nonsteroidal anti-inflammatory drug for preventing PEP cannot be recommended.
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KEYWORD
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Cholangiopancreatography, endoscopic retrograde, Diclofenac, Prevention & control, Ringer’s lactate
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