KMID : 1143920200240030259
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Annals of Hepato-Biliary-Pancreatic Surgery 2020 Volume.24 No. 3 p.259 ~ p.268
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Naproxen, isosorbide dinitrate and co-administration cannot prevent post-endoscopic retrograde cholangiopancreatography pancreatitis: Randomized controlled trial
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Mansour-Ghanaei Fariborz
Joukar Farahnaz Khalesi Ali Akbar Naghipour Mohammadreza Sepehrimanesh Masood Mojtahedi Kourosh Yeganeh Sara Saedi Hamid Saeidi Asl Saba Fakhrieh
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Abstract
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Backgrounds/Aims: Acute pancreatitis is the most widespread complication of endoscopic retrograde cholangiopancreatography. Here, we investigated the efficacy of rectal suppository naproxen, sublingual isosorbide dinitrate and their co-administration in the prevention of post-ERCP pancreatitis.
Methods: This double-blind randomized clinical trial carried out from June 2015 to February 2016 at the Gastrointestinal and Liver Diseases Research Center in Rasht, Iran. A total of 585 patients were selected from candidates for diagnostic or therapeutic ERCP by using the simple sampling method. Patients divided into three groups. Group A received 500 mg naproxen, group B took 5 mg isosorbide dinitrate, and group C was co-administrated both agents before ERCP. The primary outcome measure was the development of pancreatitis onset of pain in the upper abdomen and increase of serum amylase activity more than 3 times over the upper normal limit (60-100 IU/L) within first the 24 h post-ERCP.
Results: Totally, 80 patients developed PEP included 29 (4.9%), 24 (4.1%), and 27 (4.6%) patients in groups A, B, and C, respectively (p=0.845). Longer ERCP time (p=0.041), using diazepam (p=0.033), a higher number of pancreatic ducts cannulation (p£¼0.001), pancreatic duct injection (p=0.013), and using pancreatic stent (p=0.004) were the predisposing factors for PEP.
Conclusions: Our findings indicated that prophylactic naproxen suppository or isosorbide dinitrate sublingually or co-administration had no significant difference in the prevention and severity of PEP, however, enhancing the endoscopist¡¯s skills can be effective. Departments and educational hospitals should develop their assessment and quality assurance measures for the training of fellows¡¯ not only technical training but also an understanding of the diagnostic and therapeutic roles of the procedure.
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KEYWORD
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ERCP, Pancreatitis, Naproxen, Isosorbide dinitrate
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