Abstract
Objective:To determine efficacy of diclofenac suppository in reducing post-ERCP pancreatitis (PEP) and identify risk factors for PEP.Methods:This is a placebo-based prospective study at Department of Medicine & Gastroenterology, Services Institute of Medical Sciences / Services Hospital, Lahore performed from January 2018 to June 2019. Patients were randomized to receive diclofenac suppository or glycerine suppository before ERCP. Both groups were compared for PEP using chi square x2 test while risk factors for PEP were determined using binary logistic regression.Results:Total of 165 patients with mean age 49.1(±15.2) and male to female ratio 1/1.6 (63/102) were included. Among 82 (49.7%) patients in diclofenac group, 8 (9.7%) developed pancreatitis while 19(22.9%) of 83(50.3%) in placebo group had PEP (p value 0.02). After multivariate analysis, age>45 years (p value 0.014, OR 3.2), Bilirubin >3 mg/dl (p value 0.004 OR 3.58), time to cannulation> 5 minutes (p value<0.000 OR 9.2), use of precut (p value< 0.000 OR 4.9), pancreatic duct cannulation (p value 0.000 OR 5.46) and total procedure time >30 minutes (p value 0.01 OR 3.92) were risk factors for PEP.Conclusion:Pre-procedure Diclofenac suppository reduces post-ERCP pancreatitis. Age > 45 years, serum bilirubin > 3 mg/dl, cannulation time > 5 minutes, use of precut, pancreatic duct cannulation and procedure time > 30 minutes are risk factors for post-ERCP pancreatitis.
Highlights
Endoscopic Retrograde Cholangiopancreatography (ERCP), since its inception in 1968 has revolutionized the management of pancreatico-biliary diseases.[1]
Majority of patients were being treated for common bile duct (CBD) stones 97 (58.8%) whereas pancreatic carcinoma 17 (10.3%), cholangiocarcinoma 11 (6.7%), periampullary cancer 11 (6.7%), gall bladder CA seven (4.2%) and CBD leakage 10 (6.1%) were other major indications for ERCP
On uni-variate analysis of variables for its association with post ERCP pancreatitis (PEP), we identified age>45 years (p value 0.014, Odd’s ratio (OR) 3.2 95% CI:1.2-8.4), Bilirubin >3 mg/dl (p value 0.004, OR 3.58 95% CI: 1.48.7), time of cannulation(TTC) > 5 minutes (p value
Summary
Endoscopic Retrograde Cholangiopancreatography (ERCP), since its inception in 1968 has revolutionized the management of pancreatico-biliary diseases.[1]. With availability of sophisticated new accessories of ERCP, range of therapeutic interventions possible in ERCP has remarkably extended. This has resulted in increasing incidence of complications like post ERCP pancreatitis, cholangitis, iatrogenic bleeding, sepsis, perforation etc.[3] Complications. Pak J Med Sci March - April 2020 Vol 36 No 3 www.pjms.org.pk 426 like hypoxia, aspiration pneumonia and cardiopulmonary depression are increasing due to extended anesthesia time during these therapeutic interventions.[4]. Among all potential complications of ERCP, post ERCP pancreatitis (PEP) is a common complication associated with significant morbidity and mortality.[5] Its incidence varies between 1-40% depending on patient related co-morbidities, type of intervention, duration of procedure and expertise of endoscopist.[6] PEP is mostly selflimiting responding to conservative treatment but still caries mortality of 0.7%.6
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
