Department of Gastroenterology, The First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei, 230022, China.
Department of Gastroenterology, Suzhou First People's Hospital, Suzhou, 234000, Anhui, China.
Dig Dis Sci. 2024 Sep;69(9):3442-3449. doi: 10.1007/s10620-024-08542-2. Epub 2024 Jul 15.
Rectal indomethacin reduces pancreatitis following endoscopic retrograde cholangiopancreatography (ERCP). However, there is insufficient evidence regarding its added benefits in patients already receiving prophylactic pancreatic stenting. Our goal was to evaluate the impact of indomethacin in high-risk patients undergoing pancreatic stenting.
A cohort study was conducted on all patients who underwent the rescue cannulation technique for challenging bile duct cannulation (selected high-risk patients). Patients were split into two groups based on the prophylaxis method for post-ERCP pancreatitis (PEP): one receiving a combination of indomethacin and pancreatic stenting, while the other received pancreatic stenting alone. Comparative analyses were carried out on PEP, hyperamylasemia, gastrointestinal bleeding, and postoperative hospital stay among post-ERCP pancreatitis patients.
Between November 2017 and May 2023, a total of 607 patients with native papillae were enrolled, with 140 grouped into the indomethacin plus stent group and 467 into the stent alone group. The overall PEP rate was 4.4% in the entire cohort, with no statistical differences observed between the groups in terms of PEP rates (P = 0.407), mild PEP (P = 0.340), moderate to severe PEP (P = 1.000), hyperamylasemia (P = 0.543), gastrointestinal bleeding (P = 0.392), and postoperative hospital stay (P = 0.521). Furthermore, sensitivity analysis using multivariable analysis also validated these findings.
Indomethacin did not reduce the incidence or severity of PEP in high-risk patients who routinely received prophylactic pancreatic stent placement. Therefore, the additional administration of rectal indomethacin to further mitigate PEP appears to be not necessary.
直肠用吲哚美辛可减少内镜逆行胰胆管造影（ERCP）后的胰腺炎。然而，对于已经接受预防性胰管支架置入术的患者，其额外益处的证据不足。我们的目标是评估吲哚美辛在接受胰管支架置入术的高危患者中的作用。
对所有接受困难胆管插管的挽救性插管技术（选择的高危患者）的患者进行了队列研究。根据 ERCP 后胰腺炎（PEP）的预防方法将患者分为两组：一组接受吲哚美辛和胰管支架联合治疗，另一组仅接受胰管支架治疗。对 PEP、高淀粉酶血症、胃肠道出血和 PEP 患者的术后住院时间进行了比较分析。
2017 年 11 月至 2023 年 5 月，共有 607 例原发性乳头患者入组，其中 140 例患者被分为吲哚美辛加支架组，467 例患者被分为支架单独组。整个队列的 PEP 总发生率为 4.4%，两组间 PEP 发生率（P=0.407）、轻度 PEP（P=0.340）、中重度 PEP（P=1.000）、高淀粉酶血症（P=0.543）、胃肠道出血（P=0.392）和术后住院时间（P=0.521）均无统计学差异。此外，多变量分析的敏感性分析也验证了这些发现。
吲哚美辛不能降低常规接受预防性胰管支架置入术的高危患者 PEP 的发生率或严重程度。因此，额外给予直肠吲哚美辛以进一步减轻 PEP 似乎没有必要。
