Post-ERCP Pancreatitis: Risk factors and role of NSAIDs in primary prophylaxis

Risk of NSAIDs in Post-ERCP Pancreatitis

  • Muhammad Haseeb Nawaz Services Institute of Medical Sciences
  • Shahid Sarwar Services Institute of Medical Sciences
  • Muhammad Arif Nadeem Services Institute of Medical Sciences
Keywords: NSAIDs, Post-ERCP pancreatitis, Primary prophylaxis, Risk factors

Abstract

Objective: To determine efficacy of diclofenac suppository in reducing post-ERCP pancreatitis (PEP) and identify risk factors for PEP.

Methods: 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 x2 test while risk factors for PEP were determined using binary logistic regression.

Results: 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.

Conclusion: 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.

doi: https://doi.org/10.12669/pjms.36.3.1804

How to cite this:
Nawaz MH, Sarwar S, Nadeem MA. Post-ERCP Pancreatitis: Risk factors and role of NSAIDs in primary prophylaxis. Pak J Med Sci. 2020;36(3):426-431. doi: https://doi.org/10.12669/pjms.36.3.1804

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Author Biographies

Muhammad Haseeb Nawaz, Services Institute of Medical Sciences

Post Graduate Resident

Shahid Sarwar, Services Institute of Medical Sciences

Associate Professor of Medicine

Department of Medicine, Services Institute of Medical Sciences Lahore

Consultant Gastroenterologist

Doctors Hospital and Medical Center Lahore

Muhammad Arif Nadeem, Services Institute of Medical Sciences

Professor of Medicine

Published
2020-03-04
How to Cite
Nawaz, M., Sarwar, S., & Nadeem, M. (2020). Post-ERCP Pancreatitis: Risk factors and role of NSAIDs in primary prophylaxis. Pakistan Journal of Medical Sciences, 36(3). https://doi.org/10.12669/pjms.36.3.1804
Section
Original Articles