Digestive Disease Center, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea.
Korean J Intern Med. 2013 Mar;28(2):141-8. doi: 10.3904/kjim.2013.28.2.141. Epub 2013 Feb 27.
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.
急性胰腺炎仍然是内镜逆行胰胆管造影术（ERCP）最常见的并发症，几十年来其报道发病率变化不大。患者和操作相关的 ERCP 后胰腺炎（PEP）的危险因素已经明确。已经确定了预防 PEP 的有效措施，包括改进插管技术和胰管支架置入，以及药物干预。药物治疗已广泛应用于预防 PEP，但预防 PEP 的效果尚无定论。虽然药物预防具有吸引力，但寻找理想药物的尝试并不完整。大多数关于药物预防 PEP 的疗效的数据均来自于 PEP 平均风险患者。然而，最近发表了一项关于直肠非甾体抗炎药（NSAIDs）预防高危患者 PEP 的随机前瞻性对照试验。结果表明，直肠吲哚美辛可显著降低 PEP 的发生率。因此，在 ERCP 前后立即直肠给予双氯芬酸或吲哚美辛已常规用于预防 PEP。然而，需要更多使用大量受试者的 NSAIDs 研究来确认这些药物的预防作用，并确定它们是否与其他预防干预措施（包括胰管支架置入）协同作用。
