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  • Prophylactic...

Prophylactic pancreatic stent in addition to rectal indomethacin effective for preventing post-ERCP pancreatitis

Written By : Dr Riya Dave |Medically Reviewed By : Dr. Kamal Kant Kohli Published On 2024-02-11T18:00:19+05:30  |  Updated On 11 Feb 2024 6:00 PM IST
Prophylactic pancreatic stent in addition to rectal indomethacin effective for preventing post-ERCP pancreatitis
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Endoscopic retrograde cholangiopancreatography (ERCP) is a valuable diagnostic and therapeutic procedure, but it comes with the risk of pancreatitis, particularly in high-risk patients. A recent randomized trial assessed two preventive strategies—rectal indomethacin alone versus the combination of indomethacin plus a prophylactic pancreatic stent.

This study was published in the journal Lancet by Prof B Joseph E. and colleagues. The study aimed to evaluate efficacy and safety, providing valuable insights for enhancing post-ERCP patient care.Therandomized non-inferiority trial involving 1950 high-risk patients undergoing endoscopic retrograde cholangiopancreatography (ERCP), researchers evaluated the efficacy of two preventive strategies: rectal indomethacin alone versus the combination of indomethacin plus a prophylactic pancreatic stent.

  • The primary outcome, post-ERCP pancreatitis incidence, was 14.9% with indomethacin alone and 11.3% with the combination, resulting in a risk difference of 3.6% (95% CI 0.6–6.6; p=0.18 for non-inferiority).

  • However, a post-hoc analysis revealed the superiority of the combination strategy (p=0.011).

  • Safety outcomes, including serious adverse events, intensive care unit admission, and hospital length of stay, did not significantly differ between the two groups.

The trial concludes that, for high-risk patients undergoing ERCP, the strategy of using rectal indomethacin alone was not as effective as combining indomethacin with prophylactic pancreatic stent placement. These findings advocate for the adoption of a comprehensive approach, emphasizing the role of prophylactic stent placement in addition to indomethacin administration for optimal prevention of post-ERCP pancreatitis in high-risk patients.

Reference:

Elmunzer, B. J., Foster, L. D., Serrano, J., Coté, G. A., Edmundowicz, S. A., Wani, S., Shah, R., Bang, J. Y., Varadarajulu, S., Singh, V. K., Khashab, M., Kwon, R. S., Scheiman, J. M., Willingham, F. F., Keilin, S. A., Papachristou, G. I., Chak, A., Slivka, A., Mullady, D., … Durkalski-Mauldin, V. Indomethacin with or without prophylactic pancreatic stent placement to prevent pancreatitis after ERCP: a randomised non-inferiority trial. Lancet,2024;403(10425):450–458. https://doi.org/10.1016/s0140-6736(23)02356-5


LancetERCPPancreatitis PreventionIndomethacinProphylactic StentEndoscopyGastroenterologyPostoperative Complications
Source : Lancet
Dr Riya Dave
Dr Riya Dave

    Dr Riya Dave has completed dentistry from Gujarat University in 2022. She is a dentist and accomplished medical and scientific writer known for her commitment to bridging the gap between clinical expertise and accessible healthcare information. She has been actively involved in writing blogs related to health and wellness.

    Dr. Kamal Kant Kohli
    Dr. Kamal Kant Kohli

    Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751

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