Nawaz Muhammad Haseeb, Sarwar Shahid, Nadeem Muhammad Arif
Dr. Muhammad Haseeb Nawaz, MBBS, Post Graduate Resident, Medical Unit-III, Department of Medicine & Gastroenterology, Services Institute of Medical Sciences, Lahore, Pakistan.
Dr. Shahid Sarwar, MBBS, FCPS (Med), FCPS (Gastroenterol), MCPS-HPE, FRCP (Edin) Associate Professor, Medical Unit-III, Department of Medicine & Gastroenterology, Services Institute of Medical Sciences, Lahore, Pakistan.
Pak J Med Sci. 2020 Mar-Apr;36(3):426-431. doi: 10.12669/pjms.36.3.1804.
To determine efficacy of diclofenac suppository in reducing post-ERCP pancreatitis (PEP) and identify risk factors for PEP.
This is a placebo-based prospective study at Department of Medicine & Gastroenterology, Services Institute of Medical Sciences / Services Hospital, Lahore performed from January 2018 to June 2019. Patients were randomized to receive diclofenac suppository or glycerine suppository before ERCP. Both groups were compared for PEP using chi square x test while risk factors for PEP were determined using binary logistic regression.
Total of 165 patients with mean age 49.1(±15.2) and male to female ratio 1/1.6 (63/102) were included. Among 82 (49.7%) patients in diclofenac group, 8 (9.7%) developed pancreatitis while 19(22.9%) of 83(50.3%) in placebo group had PEP (p value 0.02). After multivariate analysis, age>45 years (p value 0.014, OR 3.2), Bilirubin >3 mg/dl (p value 0.004 OR 3.58), time to cannulation> 5 minutes (p value<0.000 OR 9.2), use of precut (p value< 0.000 OR 4.9), pancreatic duct cannulation (p value 0.000 OR 5.46) and total procedure time >30 minutes (p value 0.01 OR 3.92) were risk factors for PEP.
Pre-procedure Diclofenac suppository reduces post-ERCP pancreatitis. Age > 45 years, serum bilirubin > 3 mg/dl, cannulation time > 5 minutes, use of precut, pancreatic duct cannulation and procedure time > 30 minutes are risk factors for post-ERCP pancreatitis.
确定双氯芬酸栓剂在降低内镜逆行胰胆管造影术（ERCP）后胰腺炎（PEP）发生率方面的疗效，并识别PEP的危险因素。
这是一项在拉合尔医学科学服务研究所/服务医院内科与胃肠病科进行的基于安慰剂的前瞻性研究，研究时间为2018年1月至2019年6月。患者在ERCP术前被随机分配接受双氯芬酸栓剂或甘油栓剂。使用卡方检验比较两组的PEP发生率，同时使用二元逻辑回归确定PEP的危险因素。
共纳入165例患者，平均年龄49.1（±15.2）岁，男女比例为1/1.6（63/102）。双氯芬酸组82例（49.7%）患者中，8例（9.7%）发生胰腺炎，而安慰剂组83例（50.3%）中的19例（22.9%）发生PEP（p值0.02）。多因素分析后，年龄>45岁（p值0.014，比值比3.2）、胆红素>3mg/dl（p值0.004，比值比3.58）、插管时间>5分钟（p值<0.000，比值比9.2）、使用预切开术（p值<0.000，比值比4.9）、胰管插管（p值0.000，比值比5.46）以及总操作时间>30分钟（p值0.01，比值比3.92）是PEP的危险因素。
ERCP术前使用双氯芬酸栓剂可降低术后胰腺炎发生率。年龄>45岁、血清胆红素>3mg/dl、插管时间>5分钟、使用预切开术、胰管插管以及操作时间>30分钟是ERCP术后胰腺炎的危险因素。
