Clinical

Prophylactic NSAID reduces post-endoscopy pancreatitis

Last Updated: 2008-05-19 17:20:21 -0400 (Reuters Health)

By Martha Kerr

SAN DIEGO (Reuters Health) - A single-dose of a non-steroidal anti-inflammatory drug (NSAID), administered rectally just prior to endoscopic retrograde cholangiopancreatography, can reduce the risk of procedure-related pancreatitis by 64%, investigators announced over the weekend here as temperatures climbed to a record-high 100 degrees.

The prevalence of post-ERCP pancreatitis ranges from 1% to 2% in low-risk patients to approximately 45% in high-risk patients, principal investigator Dr. B. Joseph Elmunzer of the University of Michigan, Ann Arbor, told attendees of Digestive Disease Week 2008.

"Post-ERCP pancreatitis is not a small problem. It causes significant morbidity and even mortality," he added.

Dr. Elmunzer and colleagues conducted a meta-analysis that included 912 patients who underwent ERCP between 2003 and 2007. The treatment group received prophylactic NSAID with indomethacin or diclofenac primarily administered rectally.

Patients who were given an NSAID had a 64% reduction in the risk of post-ERCP pancreatitis. "To put it another way, you would have to give 15 patients (prophylactic) NSAIDs to prevent one case of pancreatitis," Dr. Elmunzer explained. "Most surgeons would agree that this is a reasonable number to cover the risk."

"We don't know if the anti-inflammatory effect occurs through a COX-1 or a COX-2 pathway or by some other mechanism...Diclofenac showed a stronger effect than indomethacin," Dr. Elmunzer commented in an interview with Reuters Health after his presentation.

"We're not sure this (risk reduction) will pan out in future studies," he continued. The findings "certainly aren't practice-changing at this point, but the risk with NSAIDs is so low that in my mind the benefits far outweigh the risk."

Rectal administration could be a key in risk reduction, he added. Of the five studies using prophylactic NSAIDs, one "involved oral administration and we didn't see the same degree of the benefit in that trial. Oral administration may miss the boat just a little bit, with its slower onset of action and lower anti-inflammatory effect in the gut."