ISSN: 2008-2258
Vol 13, (2020): Supplement1- Winter
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,
,
,
Page S81-S88
https://doi.org/10.22037/ghfbb.v13i1.2208
Abstract
Aim: The main complication of Endoscopic retrograde cholangiopancreatography (ERCP) is post-ERCP pancreatitis (PEP).
Background: Based on demographic characteristics and underlying issues and ERCP indication, patients are categorized as high risk or low risk. There have been no studies on the synergistic effects of NSAIDS and hydration therapy, separately sorted by the risk assessment of PEP in different groups of patients.
Methods: This study included 281 eligible participants after exclusion. According to demographic characteristics and co-morbidities, the patients were divided to high risk and low risk. The high-risk group was divided randomly into two subgroups and both of them received NSAIDs (100 mg rectal Diclofenac). One group received standard hydration (1.5mg/kg/hr), another the other received aggressive hydration (3mg/kg/h). The low-risk group received standard hydration. One of its subgroups received NSAIDs, while others did not. The efficacy of these preventions was compared across 4 subgroups.
Results: The mean age was 59.85±17.17. Eight hours after ERCP, the amylase and lipase were significantly higher in the 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 of 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, the low-risk group was exposed to the lowest risk of PEP. NSAIDs could not help to decrease the rate PEP in the low-risk groups alone. Overall, it seems hydration and NSAIDs therapy had synergistic outcome in high-risk patients.
Keywords: Endoscopic retrograde cholangiopancreatography (ERCP), post ERCP pancreatitis.
(Please cite as: Aghajanpoor Pasha M, Eslami p, Dooghaie Moghadam A, Moazzami B, shojaee S, Almasi F, et al. The synergistic impact of NSAIDs and aggressive hydration therapy on the rate of post-ERCP pancreatitis in high -risk and low -risk patients. Gastroenterol Hepatol Bed Bench 2020;13(Suppl.1):S81-S88).
- Keywords: Endoscopic retrograde cholangiopancreatography (ERCP), post ERCP pancreatitis.
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References
McCune WS, Shorb PE, Moscovitz H. Endoscopic cannulation of the ampulla of vater: a preliminary report. Ann Surg 1968;167:752-6.
Committee ASoP, Anderson MA, Fisher L, Jain R, Evans JA, Appalaneni V, et al. Complications of ERCP. Gastrointest Endosc 2012;75:467-73.
Kochar B, Akshintala VS, Afghani E, Elmunzer BJ, Kim KJ, Lennon AM, et al. Incidence, severity, and mortality of post-ERCP pancreatitis: a systematic review by using randomized, controlled trials. Gastrointest Endosc 2015;81:143-9.
Wu D, Wan J, Xia L, Chen J, Zhu Y, Lu N. The Efficiency of Aggressive Hydration With Lactated Ringer Solution for the Prevention of Post-ERCP Pancreatitis: A Systematic Review and Meta-analysis. J Clin Gastroenterol 2017;51:e68-76.
Sotoudehmanesh R, Ali-Asgari A, Khatibian M, Mohamadnejad M, Merat S, Sadeghi A, et al. Pharmacological prophylaxis versus pancreatic duct stenting plus pharmacological prophylaxis for prevention of post-ERCP pancreatitis in high risk patients: a randomized trial. Endoscopy 2019;51:915-21.
Choudhary A, Bechtold ML, Arif M, Szary NM, Puli SR, Othman MO, et al. Pancreatic stents for prophylaxis against post-ERCP pancreatitis: a meta-analysis and systematic review. Gastrointest Endosc 2011;73:275-82.
Patai Á, Solymosi N, Mohácsi L, Patai Á V. Indomethacin and diclofenac in the prevention of post-ERCP pancreatitis: a systematic review and meta-analysis of prospective controlled trials. Gastrointest Endosc 2017;85:1144-56.
Dumonceau JM, Andriulli A, Elmunzer BJ, Mariani A, Meister T, Deviere J, et al. Prophylaxis of post-ERCP pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - updated June 2014. Endoscopy 2014;46:799-815.
Smeets XJNM, da Costa DW, Fockens P, Mulder CJJ, Timmer R, Kievit W, et al. Fluid hydration to prevent post-ERCP pancreatitis in average- to high-risk patients receiving prophylactic rectal NSAIDs (FLUYT trial): study protocol for a randomized controlled trial. Trials 2018;19:207.
Sagi SV, Schmidt S, Fogel E, Lehman GA, McHenry L, Sherman S, et al. Association of greater intravenous volume infusion with shorter hospitalization for patients with post-ERCP pancreatitis. J Gastroenterol Hepatol 2014;29:1316-20.
Shaygan-Nejad A, Masjedizadeh AR, Ghavidel A, Ghojazadeh M, Khoshbaten M. Aggressive hydration with Lactated Ringer's solution as the prophylactic intervention for postendoscopic retrograde cholangiopancreatography pancreatitis: A randomized controlled double-blind clinical trial. J Res Med Sci 2015;20:838-43.
Zhang ZF, Duan ZJ, Wang LX, Zhao G, Deng WG. Aggressive Hydration With Lactated Ringer Solution in Prevention of Postendoscopic Retrograde Cholangiopancreatography Pancreatitis: A Meta-analysis of Randomized Controlled Trials. J Clin Gastroenterol 2017;51:e17-26.
Mok SRS, Ho HC, Shah P, Patel M, Gaughan JP, Elfant AB. Lactated Ringer's solution in combination with rectal indomethacin for prevention of post-ERCP pancreatitis and readmission: a prospective randomized, double-blinded, placebo-controlled trial. Gastrointest Endosc 2017;85:1005-13.
Williams EJ, Taylor S, Fairclough P, Hamlyn A, Logan RF, Martin D, et al. Risk factors for complication following ERCP; results of a large-scale, prospective multicenter study. Endoscopy 2007;39:793-801.
Li G-Z, Wang F, Fang J, Zha H-L, Zhao Q. Risk Factors for Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis: Evidence from 1786 Cases. Med Sci Monit 2018;24:8544-52.
Lee YK, Yang MJ, Kim SS, Noh CK, Cho HJ, Lim SG, et al. Prediction of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis Using 4-Hour Post-Endoscopic Retrograde Cholangiopancreatography Serum Amylase and Lipase Levels. J Korean Med Sci 2017;32:1814-9.
Testoni PA, Caporuscio S, Bagnolo F, Lella F. Twenty-four-hour serum amylase predicting pancreatic reaction after endoscopic sphincterotomy. Endoscopy 1999;31:131-6.
Coté GA. Intravenous Hydration for the Prevention of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis. Gastroenterology 2014;146:581-2.
Radadiya D, Devani K, Arora S, Charilaou P, Brahmbhatt B, Young M, et al. Peri-Procedural Aggressive Hydration for Post Endoscopic Retrograde Cholangiopancreatography (ERCP) Pancreatitis Prophylaxsis: Meta-analysis of Randomized Controlled Trials. Pancreatology 2019;19:819-27.
Choi JH, Kim HJ, Lee BU, Kim TH, Song IH. Vigorous Periprocedural Hydration With Lactated Ringer's Solution Reduces the Risk of Pancreatitis After Retrograde Cholangiopancreatography in Hospitalized Patients. Clin Gastroenterol Hepatol 2017;15:86-92.
Hamada T, Nakai Y, Isayama H, Koike K. Toward routine use of non-steroidal anti-inflammatory drugs for patients undergoing endoscopic retrograde cholangiopancreatography. Dig Endosc 2017;29:291-3.
Hosseini M, Shalchiantabrizi P, Yektaroudy K, Dadgarmoghaddam M, Salari M. Prophylactic Effect of Rectal Indomethacin Administration, with and without Intravenous Hydration, on Development of Endoscopic Retrograde Cholangiopancreatography Pancreatitis Episodes: A Randomized Clinical Trial. Arch Iranian Med 2016;19:538-43.
Del Olmo Martínez L, Velayos Jiménez B, Almaraz Gómez A. Rectal diclofenac does not prevent post-ERCP pancreatitis in consecutive high-risk and low-risk patients. Rev Esp Enferm Dig 2018;110:505-9.
Feng Y, Navaneethan U, Zhu X, Varadarajulu S, Schwartz I, Hawes R, et al. Prophylactic rectal indomethacin may be ineffective for preventing post-endoscopic retrograde cholangiopancreatography pancreatitis in general patients: A meta-analysis. Dig Endosc 2017;29:272-80.
Lyu Y, Cheng Y, Wang B, Xu Y, Du W. What is impact of nonsteroidal anti-inflammatory drugs in the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis: a meta-analysis of randomized controlled trials. BMC Gastroenterol 2018;18:106.
Uçar R, Biyik M, Uçar E, Polat İ, Çifçi S, Ataseven H, et al. Rectal or intramuscular diclofenac reduces the incidence of pancreatitis after endoscopic retrograde cholangiopancreatography. Turk J Med Sci 2016;46:1059-63.
Khoshbaten M, Khorram H, Madad L, Ehsani Ardakani MJ, Farzin H, Zali MR. Role of diclofenac in reducing post-endoscopic retrograde cholangiopancreatography pancreatitis. J Gastroenterol Hepatol 2008;23:e11-6.
Tryliskyy Y, Bryce GJ. Post-ERCP pancreatitis: Pathophysiology, early identification and risk stratification. Adv Clin Exp Med 2018;27:149-54.
de la Morena Madrigal EJ, Rodríguez García Mª I, Galera Ródenas AB, Pérez Arellano E. Biliary cannulation effectiveness and pancreatitis risk using two early precut techniques. Rev Esp Enferm Dig 2018;110:74-81.
Gong B, Hao L, Bie L, Sun B, Wang M. Does precut technique improve selective bile duct cannulation or increase post-ERCP pancreatitis rate? A meta-analysis of randomized controlled trials. Surg Endosc 2010;24:2670-80.
Katsinelos P, Gkagkalis S, Chatzimavroudis G, Beltsis A, Terzoudis S, Zavos C, et al. Comparison of three types of precut technique to achieve common bile duct cannulation: a retrospective analysis of 274 cases. Dig Dis Sci 2012;57:3286-92.
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