Comparison of rectal indomethacin, diclofenac, and naproxen for the prevention of post endoscopic retrograde cholangiopancreatography pancreatitis

• Published in: European journal of gastroenterology & hepatology Vol. 29; no. 3; p. 349
• Main Authors: Mohammad Alizadeh, Amir H, Abbasinazari, Mohammad, Hatami, Behzad, Abdi, Saeed, Ahmadpour, Forozan, Dabir, Shideh, Nematollahi, Aida, Fatehi, Samira, Pourhoseingholi, Mohammad A
• Format: Journal Article
• Language: English
• Published: England 01.03.2017
• Subjects: Administration, Rectal; Adult; Aged; Amylases - blood; Anti-Inflammatory Agents, Non-Steroidal - administration & dosage; Anti-Inflammatory Agents, Non-Steroidal - adverse effects; Biomarkers - blood; Cholangiopancreatography, Endoscopic Retrograde - adverse effects; Diclofenac - administration & dosage; Diclofenac - adverse effects; Double-Blind Method; Eicosapentaenoic Acid - analogs & derivatives; Eicosapentaenoic Acid - blood; Female; Humans; Incidence; Indomethacin - administration & dosage; Indomethacin - adverse effects; Iran - epidemiology; Lipase - blood; Lipoxins - blood; Male; Middle Aged; Naproxen - administration & dosage; Naproxen - adverse effects; Pancreatitis - blood; Pancreatitis - diagnosis; Pancreatitis - epidemiology; Pancreatitis - prevention & control; Risk Factors; Time Factors; Treatment Outcome
• ISSN: 1473-5687
• DOI: 10.1097/MEG.0000000000000787

NSAIDs are commonly utilized for the prevention of post endoscopic retrograde cholangiopancreatography pancreatitis (PEP). However, not much is known about the most effective drug in preventing this complication. This study aims to clarify which drug (indomethacin, diclofenac, or naproxen) is most effective for the prevention of post endoscopic retrograde cholangiopancreatography (ERCP). In a double-blind, randomized study, patients received a single rectal dose of one of the three drugs 30 min before undergoing ERCP: diclofenac (100 mg), indomethacin (100 mg), or naproxen (500 mg). The primary outcome measured was the development of pancreatitis. The levels of serum amylase, lipase, lipoxin A4, and resolvin E1 were measured before ERCP, and at 24 h after the procedure. Three hundred and seventy-two patients completed the study. The overall incidence of PEP was 8.6%, which occurred in five of the 124 (4%) patients who received diclofenac, seven of the 122 (5.8%) patients who received indomethacin, and 20 of the 126 (15.9%) patients who received naproxen. There were no significant differences in amylase and lipase levels among the three groups (P=0.183 and 0.597, respectively). Unlike patients in the naproxen group, patients in the diclofenac and indomethacin groups showed a significant increase in lipoxin A4 and resolvin E1 (P=0.001 and 0.02, respectively). Diclofenac and indomethacin patient groups had a lower incidence of PEP than the naproxen group.