RECTAL DICLOFENAC DOES NOT PREVENT POST-ERCP PANCREATITIS IN HIGH AND LOW RISK CONSECUTIVE PATIENTS

Aims:

Rectal diclofenac, a nonsteroidal anti-inflammatory drug (NSAID), is used to prevent pancreatitis in high-risk patients during an endoscopic retrogade cholangiopancreatography (ERCP). The European Society of Gastrointestinal Endoscopy (ESGE) recommends prophylaxis with indometacin or diclofenac in all patients undergoing an ERCP, even those with medium-risk and low-risk pancreatitis. We have conducted a study to research the effectiveness of this recommendation.

Methods:

This is a mixed cohort study. We collected 1512 ERCPs carried out at the Hospital Clínico in Valladolid (Spain) between January of 2009 and July of 2017. The 718 patients treated until June of 2012 were not given diclofenac. After this date, were given 100 mg of rectal diclofenac all patients without any contraindication adding up to 794. All post-ERCP pancreatitis (PEP) predisposing factors and all PEP cases defined by consensus criteria were collected in the study.

Results:

There were 47 PEP (3.1%), 3.4% (27) of the patients treated with diclofenac and 2.8% (20) of the patients without this treatment (p = 0.554). Within the group of patients given diclofenac, there were 4.4%, 0.5% and 2.6% of PEP cases with native papillae, previous sphincterotomy and enlarged sphincterotomy respectively. These percentages were very similar to those of the group of patients who were not given diclofenac (4% of native papillae, 0.9% of previous sphincterotomy and 2.5% of ampliacion cases). The PEP severity was similar in both groups of patients as well as the adverse effects. We have also seen that, from the 26.1% of high-risk patients, there are no PEP differences either (p = 0.311).

Conclusions:

Rectal diclofenac administered to consecutive patients before undergoing an ERCP does not prevent the appearance of PEP.