Kato Kunihiro, Shiba Masatsugu, Kakiya Yuki, Maruyama Hirotsugu, Ominami Masaki, Fukunaga Shusei, Sugimori Satoshi, Nagami Yasuaki, Watanabe Toshio, Tominaga Kazunari, Fujiwara Yasuhiro
From the Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan.
Pancreas. 2017 Aug;46(7):880-886. doi: 10.1097/MPA.0000000000000852.
Rectal nonsteroidal anti-inflammatory drugs have reported promising prophylactic activity in post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). Conversely, cyclooxygenase-2 enzyme has been suggested to contribute to experimental acute pancreatitis. The aim of this study was to evaluate the efficacy of oral administration of celecoxib, a cyclooxygenase-2 inhibitor, for the prevention of PEP.
We performed a prospective randomized controlled study. Patients who were scheduled to undergo ERCP were randomized to receive either oral 400-mg celecoxib tablets 1 hour before ERCP and saline infusion (celecoxib group) or saline infusion only (control group). The primary outcome measure was the frequency of PEP.
A total of 170 patients were randomized; 85 patients each in the celecoxib group and control group were analyzed. After the procedure, 23 patients (13.5%) developed PEP. There was no difference in the frequency of PEP between the 2 groups (control group vs celecoxib group, 15.3% (13/85) vs 11.7% (10/85); P = 0.65). The severity of PEP, asymptomatic hyperamylasemia, and post-ERCP pain were not significantly different between the 2 groups. There were no adverse events related to celecoxib treatment.
Oral administration of celecoxib had no beneficial preventive effect on PEP.
有报告称直肠非甾体抗炎药在内镜逆行胰胆管造影术（ERCP）后胰腺炎（PEP）的预防中具有良好的活性。相反，有研究表明环氧合酶-2（COX-2）酶在实验性急性胰腺炎中起作用。本研究旨在评估口服COX-2抑制剂塞来昔布预防PEP的疗效。
我们进行了一项前瞻性随机对照研究。计划接受ERCP的患者被随机分为两组，一组在ERCP前1小时口服400mg塞来昔布片并输注生理盐水（塞来昔布组），另一组仅输注生理盐水（对照组）。主要观察指标是PEP的发生率。
共有170例患者被随机分组；塞来昔布组和对照组各85例患者纳入分析。术后，23例患者（13.5%）发生了PEP。两组之间PEP的发生率无差异（对照组vs塞来昔布组，15.3%（13/85）vs 11.7%（10/85）；P = 0.65）。两组之间PEP的严重程度、无症状高淀粉酶血症和ERCP后疼痛无显著差异。未发生与塞来昔布治疗相关的不良事件。
口服塞来昔布对PEP无有益的预防作用。
