The synergistic impact of NSAIDs and aggressive hydration therapy on the rate of post-ERCP pancreatitis in high risk and low risk patients.
Gastroenterology and Hepatology from Bed to Bench,
,
9 December 2020
https://doi.org/10.22037/ghfbb.v13i1.2208
Abstract
Abstract
Background: The main complication of Endoscopic retrograde cholangiopancreatography (ERCP) is post-ERCP pancreatitis (PEP). Patients according to demographic characteristics and underlying issues or the reason of ERCP indication are categorized as high risk or low risk patients. Previous investigations represented the effective role of NSAIDS or hydration therapy before the ERCP in reduction PEP. Nevertheless, there is no available evidence about the evaluation the synergistic effects of NSAIDS and hydration therapy, separately sorted by the risk assessment of PEP in different groups of patients.
Method: This study included 281 eligible participants after exclusion. The patients according to demographic characteristics and co-morbidities were divided to high risk and low risk participants. High risk group was divided randomly to two subgroups. both of them received NSAIDs (100 mg rectal Diclofenac). In one group received standard hydration (1.5mg/kg/hr), another group received aggressive hydration (3mg/kh/h). Low risk group received standard hydration. One of its subgroups received NSAID, other not. The efficacy of these preventions were compared between 4 subgroups.
Result: the mean age was 59.85±17.17. The amylase and lipase 8 hours after ERCP were significantly higher in high risk group with standard hydration (P=0.00). amylase, lipase 8 hours, between two low risk subgroups, NSAIDs had no significant effect (P=0.38, P=0.95, respectively). After adjustment based on cannulation, manipulation and duration time, the results had no change (P=0.64, P=0.19, P=0.61).
Conclusion: the aggressive hydration could significantly decrease the risk of PEP. However, still, the low risk group exposed lowest risk of PEP. NSAIDS, could not alone help to decrease the rate PEP in low risk groups. Overall, it seems hydration and NSAIDs therapy had synergistic outcome in high risk patients.
- Keywords: Endoscopic retrograde cholangiopancreatography (ERCP), post ERCP pancreatitis.
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