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Original Article
 
Role of rectal diclofenac suppository for prevention and its impact on severity of post-ERCP pancreatitis in high risk patients
Sandeep Patil1, Vikas Pandey1, Nilesh Pandav1, Meghraj Ingle1, Aniruddha Phadke1, Prabha Sawant1
1Department of Gastroenterology, Lokmanya Tilak Municipal Medical College & General Hospital, Mumbai 400022, India.

Article ID: 100042IJHPDSP2015
doi:10.5348/ijhpd-2015-42-OA-17

Address correspondence to:
Vikas Pandey
Department of Gastroenterology
LokmanyaTilak Municipal Medical College & General Hospital
Mumbai 400022
India

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How to cite this article
Patil S, Pandey V, Pandav N, Ingle M, Phadke A, Sawant P. Role of rectal diclofenac suppository for prevention and its impact on severity of post-ERCP pancreatitis in high risk patients. Int J Hepatobiliary Pancreat Dis 2015;5:97–102.


Abstract
Aims: To study the role of rectal diclofenac in prevention of post-ERCP (endoscopic retrograde cholangiopancreatography) pancreatitis and its impact on severity of post-ERCP pancreatitis.
Methods: We conducted a single centre, prospective, open labelled, randomized trial for evaluating the use of rectal diclofenac in prevention of post-ERCP pancreatitis in high risk patients. We assessed 526 patients given for ERCP for different indications. 400 patients were eligible for the study. Those not fitting the high risk criteria and with acute pancreatitis were excluded. These patients were randomized in two groups, 200 patients received rectal diclofenac prior to or during the procedure while 200 patients received placebos. Serum amylase was measured at 2 hr and 36 hr. Post-ERCP pancreatitis was defined as serum amylase > 3 times ULN associated with severe abdominal pain. Severity was graded according to days of hospitalization and complications.
Results: 29 out of 400 (7.2%) patients developed post-ERCP pancreatitis. 6 out of 200 (3%) patients in rectal diclofenac group developed post-ERCP pancreatitis compared to 23 out of 200 (11.5%) patients in placebo group. The difference was statistically significant (p=0.001). All patients (6) in rectal diclofenac group developed mild pancreatitis as compared to severe pancreatitis in four and moderate pancreatitis in five patients in the placebo group.
Conclusion: Rectal diclofenac prior to or during ERCP in high risk patient reduces the incidence as well as severity of post-ERCP pancreatitis compared to placebo.

Keywords: Post-ERCP pancreatitis, Rectal diclofenac, Sphincter of Oddi dysfunction

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Author Contributions:
Sandeep Patil – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Vikas Pandey – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Nilesh Pandav – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Meghraj Ingle – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Aniruddha Phadke – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Prabha Sawant – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2015 Sandeep Patil et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.