Koshitani Tatsuya, Konaka Yoshitomo, Ohishi Takashi, Yasuda Tomoyo, Morinushi Tatsuo, Mita Masaki, Masuda Masataka, Nakano Keimei, Fuki Shuichi, Nakagawa Shuji
From the Department of Gastroenterology, Japan Community Health Care Organization, Kobe Central Hospital.
Pancreas. 2022 Jul 1;51(6):663-670. doi: 10.1097/MPA.0000000000002090. Epub 2022 Sep 13.
Both pancreatic stenting and rectal nonsteroidal anti-inflammatory drugs (NSAIDs) prevent post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. The aim of the study was to compare post-ERCP pancreatitis (PEP) prophylaxis using pancreatic stents and/or rectal NSAIDs prospectively.
A total of 321 patients undergoing ERCP were studied. Each patient was randomly allocated to receive pancreatic stent placement (PS), 50 mg of rectal diclofenac (NSAID), or both (PS + NSAID) for PEP prophylaxis. The primary outcome was the occurrence rate of PEP, and secondary outcomes included the severity of PEP and serum pancreatic amylase and lipase levels on the day after ERCP.
Five patients (PS: 2/101, NSAID: 1/106, PS + NSAID: 2/102) developed PEP, and the overall occurrence rate of PEP was 1.6% (5/309). The occurrence rates of PEP in the PS, NSAID, and PS + NSAID groups were statistically equivalent with an equivalent margin of 10%. The severity of PEP was mild in all 5 patients. Median serum pancreatic amylase and lipase levels in the NSAID group were significantly lower than those in the PS and PS + NSAID groups.
Rectal administration of 50 mg of diclofenac may become a first-line therapy for PEP prophylaxis in our country.
胰管支架置入术和直肠非甾体抗炎药（NSAIDs）均可预防内镜逆行胰胆管造影术（ERCP）后胰腺炎。本研究旨在前瞻性比较使用胰管支架和/或直肠NSAIDs预防ERCP后胰腺炎（PEP）的效果。
共纳入321例行ERCP的患者。每位患者被随机分配接受胰管支架置入（PS）、50mg直肠双氯芬酸（NSAID）或两者联合（PS + NSAID）以预防PEP。主要结局是PEP的发生率，次要结局包括PEP的严重程度以及ERCP术后次日血清胰淀粉酶和脂肪酶水平。
5例患者（PS组：2/101，NSAID组：1/106，PS + NSAID组：2/102）发生PEP，PEP的总体发生率为1.6%（5/309）。PS组、NSAID组和PS + NSAID组的PEP发生率在统计学上相当，等效界值为10%。所有5例患者的PEP严重程度均为轻度。NSAID组血清胰淀粉酶和脂肪酶水平的中位数显著低于PS组和PS + NSAID组。
直肠给予50mg双氯芬酸可能成为我国预防PEP的一线治疗方法。
