Int J Gastrointest Interv.  2023 Apr;12(2):87-92. 10.18528/ijgii220043.

The role of rectal diclofenac and aggressive hydration with Ringer’s lactate in preventing post-endoscopic retrograde cholangiopancreatography pancreatitis in high-risk patients

• Sharma VM
• Mathur A
• Goyal MB
• Jat SL

• KMID: 2541772
• DOI: http://doi.org/10.18528/ijgii220043

Abstract

Background
Post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) is a common complication of therapeutic endoscopy. The aim of this trial was to determine whether a combination of rectal diclofenac and vigorous hydration with Ringer’s lactate is superior to the corresponding individual treatments for preventing PEP in high-risk patients.
Methods
This randomized, open-label, controlled trial was conducted from August 2020 to January 2022. We included patients who were at high risk of developing PEP. Three intervention groups were made: group A, diclofenac sodium suppository (100 mg); group B, aggressive hydration with Ringer’s lactate; group C, a combination of diclofenac and aggressive hydration. PEP was defined as a serum amylase level > 3 times the upper limit of normal with epigastric pain within 24 hours after endoscopic retrograde cholangiopancreatography.
Results
A total of 144 patients were included and 48 cases were randomized to each intervention group. The incidence of PEP was 8.3%, 10.4%, and 8.3% in groups A, B, and C, respectively. A personal history of alcohol consumption and more than one pancreatic duct guidewire cannulation were significantly associated with the development of PEP.
Conclusion
No difference in the incidence of PEP was observed with or without the use of aggressive hydration. Combining aggressive hydration with a rectal nonsteroidal anti-inflammatory drug for preventing PEP cannot be recommended.

Keyword

Cholangiopancreatography; endoscopic retrograde; Diclofenac; Prevention & control; Ringer’s lactate