Mohammad Alizadeh Amir H, Abbasinazari Mohammad, Hatami Behzad, Abdi Saeed, Ahmadpour Forozan, Dabir Shideh, Nematollahi Aida, Fatehi Samira, Pourhoseingholi Mohammad A
aGastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases bDepartment of Clinical Pharmacy, School of Pharmacy cDepartment of Anesthesiology, Akhtar Hospital, Shahid Beheshti University of Medical Sciences dDepartment of Clinical Pharmacy, Islamic Azad University of Pharmaceutical Sciences Branch, Tehran, Iran.
Eur J Gastroenterol Hepatol. 2017 Mar;29(3):349-354. 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.
非甾体抗炎药（NSAIDs）常用于预防内镜逆行胰胆管造影术后胰腺炎（PEP）。然而，对于预防该并发症的最有效药物知之甚少。本研究旨在明确哪种药物（吲哚美辛、双氯芬酸或萘普生）对预防内镜逆行胰胆管造影术（ERCP）最为有效。
在一项双盲随机研究中，患者在接受ERCP前30分钟经直肠单次给予三种药物之一：双氯芬酸（100毫克）、吲哚美辛（100毫克）或萘普生（500毫克）。测量的主要结局是胰腺炎的发生情况。在ERCP前及术后24小时测量血清淀粉酶、脂肪酶、脂氧素A4和消退素E1的水平。
372例患者完成了研究。PEP的总体发生率为8.6%，其中接受双氯芬酸的124例患者中有5例（4%）发生，接受吲哚美辛的122例患者中有7例（5.8%）发生，接受萘普生的126例患者中有20例（15.9%）发生。三组间淀粉酶和脂肪酶水平无显著差异（分别为P = 0.183和0.597）。与萘普生组患者不同，双氯芬酸组和吲哚美辛组患者的脂氧素A4和消退素E1显著升高（分别为P = 0.001和0.02）。
双氯芬酸组和吲哚美辛组患者的PEP发生率低于萘普生组。
