Incidence Of post-ERCP Pancreatitis Research Articles

Su1688 Proton Pump Inhibitor (PPI) Does Not Prevent Post-ERCP Pancreatitis

Su1688 Proton Pump Inhibitor (PPI) Does Not Prevent Post-ERCP Pancreatitis Mohamed M. Abdelfatah*, Rabih Nayfe, ALA Nijim, Markus Agito, Nairmeen Haller AGMC, Northeast Ohio university, Akron, OH Background: Post-ERCP pancreatitis (PEP) is a feared complication of ERCP, and occurs in up to 20% of high-risk patients. Proton pump inhibitors (omeprazole, esomeprazole) are widely used for different indications; their therapeutic role in pancreatitis is unclear. Methods: A single-center retrospective case-control study was conducted to evaluate the potential effect of PPIs in preventing PEP. All patients who underwent ERCP between January 2007 and February 2012 were included. After obtaining IRB approval, all medical records were reviewed and data was collected for laboratory blood work done before and after the procedure, home and newly prescribed medications, in addition to the detailed operative notes. PEP was defined based on new onset abdominal pain requiring hospitalization for at least 2 nights and elevation of lipase and/or amylase R3 times the upper limit of normal at least 24 hours after the procedure. Univariable and multivariable analyses were performed to compare rates of PEP in the group of patients who received IV antibiotics, PPI, or both; analysis adjusted for potential or suspected confounding factors. Results: Among the 197 ERCPs done during the study period, the average age was found to be 62.3 (86-27), 107 patients were females and average BMI was 26.9 (44.6-16.4). Laboratory blood work showed an average WBC of 7.8 (19.6-3), hematocrit of 35.7 (54-22.9), BUN of16 (36-3), creatinine of 1 (4.4-.39), AST of 97 (944-10), calcium of 8.6 (10.3-8.6) and an LDH 250 (505-153). A total of twelve patients developed PEP, out of which, nine had severe PEP, two had moderate PEP and one had mild PEP. Lipase level was (10359-4691). In-group (1) [patients who used PPI], out of ninetyeight patients, seven had PEP (6 severe PEP, 1 mild PEP) as compared to group (2) [patients who did not use PPI], where 5 patients had PEP (3 severe, 2 moderate). There was no statistically significant difference in the incidence and severity of PEP between group (1) and group (2) (p-valueZ0.538). Table 1 presents a list of variables considered in our study, that even after adjusting for these variables and exploring other models, no associations were found between PPI and PEP. [Table 1] History of PEP, female gender, difficult cannulation/failed attempt was significantly associated with an increased incidence of PEP. However, pancreatic stent placement, diabetes mellitus, obesity, and history of acute pancreatitis were not associated with increased incidence of PEP [Table 1]. High Pre-ERCP blood sugar failed to show association with PEP (p-valueZ0.0841) (Fig.1). Conclusion: Our study did not show significant evidence to support the role played by (PPI) in decreasing the incidence or severity of post-ERCP pancreatitis. Further randomized controlled studies are needed. Factors might increase or decease the incidence of PEP.

825 Early Implementation of Precut Sphincterotomy for the Prevention of Post Endoscopic Retrograde Cholangiopancreatography Pancreatitis (PEP): Cochrane Collaboration Meta-Analysis of Randomized Controlled Trials

825 Early Implementation of Precut Sphincterotomy for the Prevention of Post Endoscopic Retrograde Cholangiopancreatography Pancreatitis (PEP): Cochrane Collaboration Meta-Analysis of Randomized Controlled Trials Frances TSE*, Siwar Albashir, Yuhong Yuan, Paul Moayyedi, Grigorios I. Leontiadis, Alan N. Barkun McMaster University, Hamilton, ON, Canada; McGill Univserity, Montreal, QC, Canada Background and Aim: Precut sphincterotomy, often used as a salvage technique for difficult cannulation, is considered an independent risk factor for post-ERCP complications. It remains controversial as to whether the increased risk is due to the precut itself or to the prolonged cannulation attempts prior to the use of precut. Early use of precut has been postulated to improve cannulation success and reduce the risk of PEP. We conducted a meta-analysis of randomized controlled trials (RCTs) of a strategy of early use of precut vs. a strategy of persistent attempts with conventional cannulation (CC) +/delayed use of precut for the prevention of PEP. Methods: We searched MEDLINE, EMBASE, CENTRAL, CINAHL up to September 2013. Conference proceedings from DDW, UEGW and ACG were searched. RCTs that compared early use of precut vs. persistent attempts with CC +/delayed use of precut were included. Study selection, data extraction and quality assessment were conducted independently by two authors. Primary outcome was incidence of PEP. Secondary outcomes included severity of PEP, CBD cannulation success with the randomized technique (primary cannulation success), eventual overall CBD cannulation success, bleeding, cholangitis, perforation and mortality. Revman 5.1 was used to calculate pooled risk ratios (RR) with 95% confidence intervals (CI, MandelHaenszel method; random effects model). Heterogeneity was assessed by Chi test (P!0.15) and I test (O25%). Results: Eight RCTs (1121 participants) met the inclusion criteria. Definitions of difficult cannulation were variable. The incidence of PEP in the early precut group was 4.6% compared to 7.5% in the CC group. Among patients with difficult cannulation, there was a trend favoring the early use of precut compared to persistent attempts with CC +/delayed use of precut for the prevention of PEP (RR 0.62; 95% CI 0.38-1.01; I Z0%) (Figure 1). The early use of precut was associated with a significantly higher primary cannulation success (91.0% vs. 58.7%; RR 1.64; 95% CI 1.28-2.10; I Z88%) with no significant increase in complications compared with persistent attempts with CC +/delayed use of precut. There was no significant difference in the overall CBD cannulation success between the two strategies (RR 1.00; 95% CI 0.96-1.04; I Z28%). Conclusion: In patients with difficult CBD cannulation, the early use of precut sphincterotomy by experienced endoscopists increases the primary cannulation success and does not appear to increase the risk of PEP or other complications compared to persistent attempts with conventional cannulation. Further RCTs are needed to confirm these findings.

Su1687 Efficacy of Rectal Indomethacin in Combination With Prophylactic Pancreatic Duct Stent in Prevention of Post ERCP Pancreatitis in High-Risk Patient Population

Incidence of post ERCP pancreatitis (PEP) can be as high as 30% in high-risk patients. Rectal indomethacin has shown to decrease PEP rates to up to 9.2% as opposed to 16.9% in the placebo group in a recently published randomized controlled trial. However, the efficacy of its use in routine clinical practice is unknown.

The Effect of Indomethacin in the Prevention of Post–Endoscopic Retrograde Cholangiopancreatography Pancreatitis

Acute pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP) is a severe complication with substantial morbidity and mortality. Indomethacin has been identified to prevent this complication; however, the results using indomethacin have varied. Therefore, we performed a meta-analysis on the efficacy of rectally administered indomethacin in the prevention of post-ERCP pancreatitis (PEP). A systematic search was performed in November 2012. Randomized, placebo-controlled trials (randomized controlled trials) in adult patients that compared rectally administered indomethacin versus placebo in prevention of PEP were included. Meta-analysis was performed using a fixed-effects model to assess the primary outcome (PEP) and secondary outcomes (mild or moderate to severe PEP) using Review Manager 5.1. Four randomized controlled trials met the inclusion criteria (n = 1422). The use of indomethacin near the time of ERCP demonstrated a statistically significant decrease in PEP (odds ratio [OR], 0.49; 95% confidence interval [CI], 0.34-0.71; P < 0.01), mild PEP (OR, 0.52; 95% CI, 0.32-0.86; P = 0.01), and moderate to severe PEP (OR, 0.45; 95% CI, 0.24-0.83; P = 0.01) as compared with placebo. The number needed to treat with indomethacin to prevent 1 episode of pancreatitis is 17 patients. Rectal indomethacin significantly reduced the incidence of PEP. We recommend using indomethacin before or just after the procedure in patients undergoing ERCP.

A Randomized Trial of Rectal Indomethacin and Sublingual Nitrates to Prevent Post-ERCP Pancreatitis

Acute pancreatitis is the most common adverse event of endoscopic retrograde cholangiopancreatography (ERCP). Recent data suggest that indomethacin can reduce the risk of post-ERCP pancreatitis (PEP) in high-risk individuals. However, whether the combination of indomethacin and sublingual nitrates is superior to indomethacin alone is unknown. Therefore, we aimed to evaluate the efficacy of rectally administered indomethacin plus sublingual nitrate compared with indomethacin alone to prevent PEP. During a 17-month period, all eligible patients who underwent ERCP were enrolled in this study. We excluded patients who had undergone a prior endoscopic sphincterotomy. In a double-blind controlled randomized trial, patients received a suppository containing 100 mg of indomethacin, plus 5 mg of sublingual nitrate (group A), or a suppository containing 100 mg of indomethacin, plus sublingual placebo (group B), before ERCP. Serum amylase levels and clinically pertinent evaluations were measured in all patients after ERCP. Of the 300 enrolled patients, 150 received indomethacin plus nitrate. Thirty-three patients developed pancreatitis: 10 (6.7%) in group A and 23 (15.3%) in group B (P=0.016, risk ratio=0.39, 95% confidence intervals (CI): 0.18-0.86). More than 80% of the patients were at high risk of developing pancreatitis after ERCP. Absolute risk reduction, relative risk reduction, and number needed to treat for the prevention of PEP were 8.6% (95% CI: 4.7-14.5), 56.2% (95% CI: 50.6-60.8), and 12 (95% CI: 7-22), respectively. Combination of rectal indomethacin and sublingual nitrate given before ERCP was significantly more likely to reduce the incidence of PEP than indomethacin suppository alone. Multicenter trials to confirm these promising findings are needed.

Prevention of postendoscopic retrograde cholangiopancreatography pancreatitis: the endoscopic technique.

Pancreatitis is the most frequent and distressing complication of endoscopic retrograde cholangiopancreatography (ERCP). Many recent studies have reported the use of pharmacological agents to reduce post-ERCP pancreatitis (PEP); however, the most effective agents have not been established. Reduction in the incidence of PEP in high-risk patients has been reported through specific cannulation techniques such as guide wire-assisted cannulation and the use of pancreatic stents. The present review focuses on ERCP techniques for the prevention of PEP.

Pancreatic duct guidewire pre-occupying for difficult biliary cannulation in ERCP

Objective To investigate the efficacy of pancreatic duct guidewire pre-occupying in ERCP with difficult biliary cannulation. Methods During a four-year study period from June 2008 to June 2012, a total of 3505 patients were included in this retrospective analysis. Initial biliary cannulation method consisted of single-guidewire technique for up to 5 attempts, followed by double-guidewire technique when repeated unin- tentional pancreatic duct cannulation had taken place. Pre-cut papillotomy technique was reserved for when double-guidewire technique had failed or no pancreatic duct cannulation had been previously achieved. Biliary cannulation success and post- ERCP complication rate were compared. Results Single-guidewire technique was characterized by statistically significant higher success rate （93.4%）, compared with the double-guide- wire technique （54. 8%, P 〈 0. 001 ）, pre-cut failed double-guidewire technique （81.3%, P 〈 0. 001 ） or pre- cut as first step method （84. 6%, P =0. 011 ）. Pre-cut failed double-guidewire technique and pre-cut as first step method offered a statistically significantly more favorable outcome compared with the double-guidewire technique （both P 〈 0. 001 ）. The incidence of post-ERCP pancreatitis did not differ in a statistically signifi- cant manner among the four methods. Numbers of patients who got bleeding in pre-cut papillotomy technique and sphincterotomy after successful single-guidewire technique were 5 and 2 respectively. One case of perfora- tion was recorded using pre-cut papillotomy technique. There was no procedure-related mortality within 30 days. Conclusion Although double-guidewire technique success rate proved not to be superior to single- guidewire technique or pre-cut papillotomy, it is considered highly satisfactory in terms of safety in order to avoid the risk of a pre-cut when biliary therapy is necessary in difficuh-to-cannulate cases. Key words: Cholangiopancreatography, endoscopic retrograde; Sphincterotomy, endoscopic ; Postoperative complications

Double Guidewire Technique for the Prevention of Post-ERCP Pancreatitis (PEP): Cochrane Collaboration Meta-analysis of RCTs

Purpose: Difficult cannulation is a risk factor for PEP. It has been postulated that the double guidewire (DGW) technique may improve biliary cannulation success and reduce the risk of PEP. We conducted a meta-analysis of randomized controlled trials (RCTs) of DGW technique vs. persistent attempts with conventional cannulation (CC), precut sphincterotomy or pancreatic duct (PD) stent in patients with difficult cannulation for the prevention of PEP. Methods: We searched Medline, Embase, Central, and CIinahl up to October, 2012. Conference proceedings were searched. RCTs that compared DGW technique vs. persistent attempts with CC, precut or PD stent in patients with difficult cannulation were included. Study selection, data extraction and quality assessment were conducted independently by two authors. Primary outcome was incidence of PEP. Secondary outcomes included CBD cannulation success with the randomized technique, overall CBD cannulation success, bleeding, cholangitis, perforation and mortality. Revman 5.1 was used to calculate pooled risk ratios (RR) with 95% confidence intervals (CI, Mandel-Haenszel method; random effects model). Heterogeneity was assessed by Chi2 test (P<0.15) and I2 test (>25%). Results: Six RCTs (503 participants) met the inclusion criteria (Figure 1). Definitions of difficult cannulation were variable. Among the two studies that compared DGW with precut, the incidence of PEP was 21.4% in the DGW group vs. 7.3% in the precut group (RR 2.83; 95% CI 0.96-8.34; I2=0%). Among the three studies that compared DGW with persistent CC, the incidence of PEP was 12.9% in the DGW group vs. 8.0% in the CC group (RR 1.63; 95% CI 0.84-3.19; I2=0%). In a post-hoc pooled analysis of the five studies that compared DGW vs. precut or persistent CC, DGW technique significantly increased the risk of PEP compared to precut or persistent CC (RR 1.90; 95% CI 1.08-3.36; I2=0%). In the one study that compared DGW vs. PD stent, there was no significant difference in the risk of PEP between the two techniques (RR 0.36; 95% CI 0.04-3.30). There was no significant difference in CBD cannulation success with the initial technique the patient was randomized to (RR 1.02; 95% CI 0.84 -1.24; I2 = 66%) or eventual overall CBD cannulation success (RR 1.05; 95% CI 0.90-1.22; I2 = 67%) between DGW technique vs. precut, persistent CC or PD stent. Conclusion: In patients with difficult CBD cannulation, the DGW technique appears to be associated with an increased risk of PEP. DGW is not superior to precut, persistent attempts with conventional cannulation or PD stent in achieving CBD cannulation. Sole DGW should be discouraged. PD stenting after use of a DGW cannulation technique may reduce the risk of PEP yet requires assessment.

Glyceryl Trinitrate for Prevention of Post-ERCP Pancreatitis and Improve the Rate of Cannulation: A Meta-Analysis of Prospective, Randomized, Controlled Trials

BackgroundAcute pancreatitis is the most common complication of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP). Several clinical trials used glyceryl trinitrate (GTN) to prevent the incidence of post-ERCP pancreatitis (PEP). However, the results were still controversial.ObjectiveTo conduct a meta-analysis of published, full-length, randomized controlled trials evaluating the effect of prophylactic GTN on the prevention of PEP, improve the rate of cannulation and the prevention of hyperamylasemia.MethodsLiterature searches were conducted using PubMed, EMBASE, The Cochrane Library and Web of Knowledge databases, using keywords "post-ERCP" and "pancreatitis" and limited in randomized controlled trials.ResultsTwelve RCTs involving 2649 patients were included. Eleven RCTs compared GTN with placebo for PEP prevention. Meta-analysis showed the overall incidence of PEP was significantly reduced by GTN treatment (RR 0.67; 95% CI, 0.52-0.87). Nevertheless, GTN administration did not decrease the incidence of moderate to severe PEP (RR 0.70; 95% CI, 0.42-1.15). Subgroup analyses revealed that GTN administered by sublingual was more effective than transdermal and topical in reducing the incidence of PEP. Besides, the prophylactic effect of GTN was far more obvious in the group of high PEP incidence than in the group of low PEP incidence. Additionally, the incidence of hyperamylasemia was significantly reduced by GTN treatment (RR 0.69; 95% CI, 0.54-0.90). No differences of the successful cannulation rate of bile ducts (RR 1.03; 95% CI, 0.99-1.06) attributable to GTN were observed.ConclusionProphylactic use of GTN reduced the overall incidence of PEP and hyperamylasemia. However, GTN was not helpful for the severity of PEP and the rate of cannulation.

Results of the Tokyo Trial of Prevention of Post-ERCP Pancreatitis with Risperidone-2: a multicenter, randomized, placebo-controlled, double-blind clinical trial

Our previous study suggested that a combination of ulinastatin and risperidone reduced post-ERCP pancreatitis (PEP) compared with ulinastatin alone. The aim of this study was to evaluate the efficacy of risperidone alone for prevention of PEP. A multicenter, randomized, placebo-controlled, double-blind clinical trial. Two academic hospitals and 5 referral hospitals in Tokyo and Saitama, Japan. Patients undergoing therapeutic or interventional-diagnostic ERCP. The patients were randomized to receive 2 mg of oral risperidone or oral placebo at 0.5 to 2 hours before ERCP. The primary endpoint was the incidence of PEP. Secondary endpoints were the incidence of hyperenzymemia and enzyme levels (amylase, pancreatic amylase, lipase). Risk factors for PEP were evaluated. We initially enrolled 500 patients in the study (250 in the risperidone group and 250 in the placebo group), but 17 (11 in the risperidone and 6 in the placebo group) were excluded after randomization. PEP developed in 24 patients (10.0%) in the risperidone group and 21 patients (8.6%) in the placebo group (P = .587). Serum amylase levels at 3 hours after ERCP were lower in the risperidone group (P = .007 in a single test of hypothesis, significance removed by Bonferroni correction for multiple testing). In multivariate analysis, a small papilla of Vater, total procedure time ≥40 minutes, and stenosis of the intrahepatic duct were significantly associated with PEP. Multiplicity of study centers and a relatively wide time range of drug administration time. Risperidone did not show a benefit in prevention of PEP in this trial. ( NCT000004592.).

Is nafamostat mesilate really effective for the prevention of post-ERCP pancreatitis?

Background/aim: Infusion of the protease inhibitor nafamostatmesilate (20 mg) effectively prevents post-ERCP pancreatitis, but only in low-risk groups in previous study. This study was performed to confirm the usefulness of nafamostat mesilate for prevention of post-ERCP pancreatitis (PEP). Methods:Atotal of 1331patientswhounderwentERCPwere included;32 patients were excluded. Patients were divided into 3 groups: controls (group A), infusionwith 20mg of nafamostat mesilate (group B), or infusionwith 50 mg of nafamostat mesilate (group C). The incidence of PEP was analyzed. Results: The overall incidence of acute pancreatitis was 6.3% (82/1299). There was a significant difference in the incidence of PEP with or without nafamostat mesilate (9.5% vs 3.6% and 5.1%, respectively; P < 0.001). Subgroup analysis showed that in low-risk patients, the rate of PEP was significantly different with nafamostat (9.4% vs 3.0% and 4.0%, respectively; P 1⁄4 0.002). But in high-risk patients, the rate of PEP was not significantly different among treatment groups (9.5% vs 4.5% and 6.9%, respectively; P1⁄4 0.110). Conclusions: Nafamostat mesilate prophylaxis (20 or 50 mg) is effective in preventing post-ERCP pancreatitis. However, the preventive effect of nafamostat mesilate is not significant in high risk patients.

The incidence of post-ERCP pancreatitis according to various cannulation methods

The incidence of post-ERCP pancreatitis according to various cannulation methods

PTH-055 To Evaluate the Frequency and Risk Factors in the Post Ercp Pancreatitis where Ercp Accessories are Reused

IntroductionDespite all the advances and improvement in ERCP techniques, post ERCP acute pancreatitis remains the most feared and common complication, being associated with high morbidity and mortality. The figures cited...

Sa1528 Pancreatic Duct Guidewire Placement for Biliary Cannulation for the Prevention of Post-ERCP Pancreatitis (PEP): Cochrane Collaboration Meta-Analysis of Randomized Controlled Trials

Sa1528 Pancreatic Duct Guidewire Placement for Biliary Cannulation for the Prevention of Post-ERCP Pancreatitis (PEP): Cochrane Collaboration Meta-Analysis of Randomized Controlled Trials

Mo1465 Is Double-Guidewire Technique Really Useful for Difficult Biliary Cannulation?

Mo1465 Is Double-Guidewire Technique Really Useful for Difficult Biliary Cannulation? Su Jin Kim*, Dae Hwan Kang, Hyung Wook Kim, Cheol Woong Choi, Young MI Hong, Joung Boom Hong, Byoung Hoon Ji, MIN Dae Kim, Jae Hyung Lee Internal Medicine, Pusan National University Yangsan Hospital, YangSan -Si, Gyeongnam, Republic of Korea; Internal Medicine, Bongseng Memorial Hospital, Pusan, Republic of Korea Background and Aim: Double-guidewire technique (DGT) has been reported to be useful for difficult biliary cannulation. Needle-knife fistulotomy (NKF) is also used in failed standard biliary cannulation. The aim of this study was to compare the success rate and complications between the DGT and NKF in patients with difficult biliary cannulations. Methods: Patient who underwent endoscopic retrograde cholangiopancreatography (ERCP) between January 2009 and September 2012 were eligible for this study. DGT or NKF were perfomed if deep biliary cannulation was not achieved despite of five mininutes of attempted cannulationthan or more than three attempted unintentional pancreatic cannulations. Patients with unsuccessful DGT underwent NKF as alternative procedure. The success rate of cannulation and the frequency of post-ERCP pancreatitis (PEP) were investigated. Result A total 1550 ERCP cases were analyzed, the total success rate of selective biliary cannulation was 94.2% (1460/1550). Of the 302 patients with unsuccessful standard cannulation technique, DGT was perfomed in 70 patients and NKF was perfomed in 199. The success rates in the DGT and NKF groups were 41.4% (29/70) versus 81.4% (162/ 199) (p 0.01). Thirty patients with unsuccessful DGT underwent NKF as alternative procedure, biliary cannulation was achieved in 70.0% (21/30). 3-step protocol (traditional cannula with guidewire, DGT, and NKF is performed sequentially) was no significant benefit in success rates compared with NKF only group (84.7% 50/59, p 0.453). The incidence rate of PEP was significantly higher in DGT group (20.0%, 14/70) than in NKF group (8.0%, 16/199) (p 0.01). There was no significant difference in bleeding incidence. Conclusion: DGT in patients with a difficult biliary cannulation resulted in a low success rate of biliary cannulation and a high incidence of PEP comparing with NKF. DGT before NKF had no statically additional benefit in cannulation success. We suggest that NKF should be considered as a first approach in difficult cannulation situations. Clinical Outcomes for cannulation

Prophylactic pancreatic stent placement and post-ERCP pancreatitis: an updated meta-analysis

Pancreatitis is one of the most frequent post-endoscopic retrograde cholangiopancreatography (ERCP) complications. Previous meta-analyses show that prophylactic pancreatic stent (PS) placement after ERCP is beneficial for the prevention of post-ERCP pancreatitis (PEP). However, the results of these meta-analyses are controversial due to the limited sample size of the eligible studies, in which six additional randomized controlled trials (RCTs) are not included. Our aim is, therefore, to update the current meta-analyses regarding PS placement for prevention of PEP. We conducted a meta-analysis to identify RCTs comparing PS placement and the subsequent incidence of PEP. The primary outcome was the incidence of PEP. Fourteen studies were enrolled in this meta-analysis. Of the 1,541 patients, 760 patients received a PS and 781 patients were allocated to the control group. PS placement was associated with a statistically significant reduction of PEP [relative risk (RR) 0.39; 95% confidence interval (CI) 0.29-0.53; P<0.001]. Subgroup analysis stratified according to the severity of PEP showed that a PS was beneficial in patients with mild to moderate PEP (RR 0.45; 95% CI 0.32-0.62; P<0.001) and in patients with severe PEP (RR 0.26; 95%CI 0.09-0.76; P=0.01). In addition, subgroup analysis performed according to patient selection demonstrated that PS placement was effective for both high-risk and mixed case groups. This meta-analysis showed that PS placement prevented PEP after ERCP as compared with no PS placement. We therefore recommend PS placement after ERCP for the prevention of PEP.

Pancreatic stents with diclofenac reduce the incidence of post ERCP pancreatitis in patients undergoing molecular screening of pancreatic juice for pancreatic cancer

Pancreatic stents with diclofenac reduce the incidence of post ERCP pancreatitis in patients undergoing molecular screening of pancreatic juice for pancreatic cancer

Pancreatic stents with diclofenac reduce the incidence of post ERCP pancreatitis in patients undergoing molecular screening of pancreatic juice for pancreatic cancer

Pancreatic stents with diclofenac reduce the incidence of post ERCP pancreatitis in patients undergoing molecular screening of pancreatic juice for pancreatic cancer

Pancreatic stents with diclofenac reduce the incidence of post ERCP pancreatitis in patients undergoing molecular screening of pancreatic juice for pancreatic cancer

s / Pancreatology 13 (2013) e1–e94 e60 months (19.3-38.6) in localized disease; 11 months (10.2-11.7) in regional stage and 3 months (2.8-3.1) in distant stage disease. Younger age, localized disease, curative intent surgery, radiotherapy, more recent year of diagnosis (2002-2008 vs 1988-1994) [but not gender, race, geographic location] were associated with increased survival. Conclusions: Although there has been a decrease in the age-adjusted incidence rate and mortality from PMC in recent years, most patients are diagnosed at an advanced stage, and this tumor has a poor prognosis. Efforts to recognize malignancy in mucinous pancreatic cysts and earlier diagnosis are warranted.

Can postendoscopic retrograde cholangiopancreatography pancreatitis be prevented by a pharmacological approach?

Acute pancreatitis remains the most frequent complication of endoscopic retrograde cholangiopancreatography (ERCP), with reported incidence rates that have changed little over several decades. Patient- and procedure-related risk factors for post-ERCP pancreatitis (PEP) are well-defined. Effective measures to prevent PEP have been identified, including improvements in cannulation techniques and pancreatic stenting, as well as pharmacological intervention. Pharmacotherapy has been widely studied in the prevention of PEP, but the effect in averting PEP has been inconclusive. Although pharmacological prophylaxis is appealing, attempts to find an ideal drug are incomplete. Most available data on the efficacy of pharmacological agents for PEP prophylaxis have been obtained from patients at average risk for PEP. However, recently, a randomized prospective controlled trial of rectal nonsteroidal anti-inflammatory drugs (NSAIDs) to prevent PEP in high-risk patients was published. The results revealed that rectal indomethacin reduced the incidence of PEP significantly. Thus, rectal administration of diclofenac or indomethacin immediately before or after ERCP is used routinely to prevent PEP. However, additional studies with NSAIDs using large numbers of subjects are necessary to confirm the prophylactic effect of these drugs and to establish whether they act synergistically with other prophylactic interventions, including pancreatic stenting.