Rainio Mia, Lindström Outi, Udd Marianne, Louhimo Johanna, Kylänpää Leena
Department of Gastrointestinal Surgery, University of Helsinki, Helsinki University Hospital, Haartmaninkatu 4, 00290, Helsinki, Finland.
J Gastrointest Surg. 2017 Aug;21(8):1270-1277. doi: 10.1007/s11605-017-3412-3. Epub 2017 Apr 3.
Nonsteroidal anti-inflammatory drugs have an inhibitory role in pathogenesis of pancreatitis. Guidelines from the European Society of Gastrointestinal Endoscopy recommend routine rectal administration of 100 mg of diclofenac or indomethacin immediately before or after ERCP for all patients without contraindications.
Our aim was to evaluate the effect of diclofenac in preventing post-ERCP pancreatitis (PEP) in a high-volume, low-PEP-risk ERCP unit.
The rate and severity of PEP were compared in groups of 1000 historical controls prior to the routine use of diclofenac and in 1000 patients receiving 100 mg diclofenac before ERCP.
PEP occurred in 56 (2.8%) of the 2000 patients, and the rate of the pancreatitis was 2.8% in control group and 2.8% in diclofenac group (p = 1.000). The PEP rate among the native papilla patients was 3.9% in control group and 3.6% in diclofenac group (p = 0.803). In subgroup analysis of patients with a high risk of PEP, diclofenac neither prevented PEP nor made its course milder.
In an unselected patient population in a center with a low incidence of PEP, diclofenac seems to have no beneficial effect.
非甾体类抗炎药在胰腺炎发病机制中具有抑制作用。欧洲胃肠内镜学会指南建议，对于所有无禁忌证的患者，在ERCP术前或术后立即常规经直肠给予100mg双氯芬酸或吲哚美辛。
我们的目的是在一个进行大量ERCP操作且发生PEP风险较低的单位中，评估双氯芬酸预防ERCP术后胰腺炎（PEP）的效果。
比较了在常规使用双氯芬酸之前的1000例历史对照患者和在ERCP术前接受100mg双氯芬酸的1000例患者中PEP的发生率和严重程度。
2000例患者中有56例（2.8%）发生PEP，对照组胰腺炎发生率为2.8%，双氯芬酸组为2.8%（p = 1.000）。在天然乳头患者中，对照组PEP发生率为3.9%，双氯芬酸组为3.6%（p = 0.803）。在PEP高风险患者的亚组分析中，双氯芬酸既不能预防PEP，也不能使其病程减轻。
在一个PEP发生率较低的中心的未选择患者群体中，双氯芬酸似乎没有有益作用。
