Author/Authors :
Aghajanpoor Pasha, Morteza Gastroenterology and Liver Diseases Research Center - Research Institute for Gastroenterology and Liver Diseases - Shahid Beheshti University of Medical Sciences - Tehran, Iran , Eslami, Pegah Gastroenterology and Liver Diseases Research Center - Research Institute for Gastroenterology and Liver Diseases - Shahid Beheshti University of Medical Sciences - Tehran, Iran , Dooghaie Moghadam, Arash Gastroenterology and Liver Diseases Research Center - Research Institute for Gastroenterology and Liver Diseases - Shahid Beheshti University of Medical Sciences - Tehran, Iran , Moazzami, Bobak Network of Immunity in Infection - Malignancy and Autoimmunity (NIIMA) - Universal Scientific Education and Research Network (USERN) - Tehran, Iran , shojaee, Sajad Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center - Research Institute for Gastroenterology and Liver Diseases - Shahid Beheshti University of Medical Sciences - Tehran, Iran , Almasi, Faezeh Department of Internal Medicine - Loghman Hakim Hospital - Shahid Beheshti University of Medical Sciences - Tehran, Iran , Tavakolikia, Narjes Population Health Department - Social and Preventive Medicine Specialist - Head of Family - Tehran University of Medical science - Tehran, Iran , Norouzinia, Mohsen Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center - Research Institute for Gastroenterology and Liver Diseases - Shahid Beheshti University of Medical Sciences - Tehran, Iran , Radinnia, Ebrahim Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center - Research Institute for Gastroenterology and Liver Diseases - Shahid Beheshti University of Medical Sciences - Tehran, Iran , Sadeghi, Amir Gastroenterology and Liver Diseases Research Center - Research Institute for Gastroenterology and Liver Diseases - Shahid Beheshti University of Medical Sciences - Tehran, Iran
Abstract :
The main complication of Endoscopic retrograde cholangiopancreatography (ERCP) is post-ERCP pancreatitis (PEP).
Background: Based on demographic characteristics and underlying issues and ERCP indication, patients are categorized as high risk
or low risk. There have been no studies on the synergistic effects of NSAIDS and hydration therapy, separately sorted by the risk
assessment of PEP in different groups of patients.
Methods: This study included 281 eligible participants after exclusion. According to demographic characteristics and co-morbidities,
the patients were divided to high risk and low risk. The high-risk group was divided randomly into two subgroups and both of them
received NSAIDs (100 mg rectal Diclofenac). One group received standard hydration (1.5mg/kg/hr), another the other received
aggressive hydration (3mg/kg/h). The low-risk group received standard hydration. One of its subgroups received NSAIDs, while
others did not. The efficacy of these preventions was compared across 4 subgroups.
Results: The mean age was 59.85±17.17. Eight hours after ERCP, the amylase and lipase were significantly higher in the high-risk
group with standard hydration (P=0.00). Amylase, lipase 8 hours, between two low risk subgroups, NSAIDs had no significant effect
(P=0.38, P=0.95, respectively). After adjustment based on cannulation, manipulation and duration of time, the results had no change
(P=0.64, P=0.19, P=0.61).
Conclusion: The aggressive hydration could significantly decrease the risk of PEP. However, the low-risk group was exposed to the
lowest risk of PEP. NSAIDs could not help to decrease the rate PEP in the low-risk groups alone. Overall, it seems hydration and
NSAIDs therapy had synergistic outcome in high-risk patients.
