Indomethacin may curb pancreatitis after cholangiopancreatography

Reuters Health Information: Indomethacin may curb pancreatitis after cholangiopancreatography

Indomethacin may curb pancreatitis after cholangiopancreatography

Last Updated: 2016-06-03

By David Douglas

NEW YORK (Reuters Health) - Rectal indomethacin may cut the risk of pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP) in a wide range of patients, suggests a new study.

As Dr. Michael L. Kochman told Reuters Health by email, "this retrospective study demonstrates that the use of a simple pharmacologic intervention can safely reduce both the incidence and severity of pancreatitis in patients undergoing ERCP, even those who have a predicted low-risk for pancreatitis."

Dr. Kochman, of the University of Pennsylvania in Philadelphia, and colleagues examined data from 2009 to 2015 on just over 2,000 patients who received indomethacin and a similar number of patients who did not. After June of 2012, most such patients received indomethacin.

Their findings appeared online May 20 in Gastroenterology.

The non-steroidal anti-inflammatory drug (NSAID) was associated with lower odds of post-ERCP pancreatitis overall (odds ratio, 0.35; p<0.001) and in particular moderate to severe disease (OR, 0.17; p<0.001). In patients with malignant obstruction, the corresponding proportions were 64% and 80% (both p<0.001).

Only 2.31% of patients with pancreatic adenocarcinoma given indomethacin developed PEP compared to 7.53% of those who did not receive the agent (p<0.001). Moreover, only 0.59% of these indomethacin recipients developed moderate to severe PEP compared to 4.32% of the other group (p=0.001).

In high-risk patients overall, the corresponding proportions were 4.50% and 8.03%. For moderate to severe PEP, they were 0.90% and 4.48%.

There was also a significant reduction in PEP and moderate to severe PEP in other specific subgroups, such as patients with gallstones and bile leaks.

Adverse events were few. Thirteen (0.65%) patients who received indomethacin developed post-procedural gastrointestinal bleeding compared to nine (0.45%) patients who did not. No patients had an allergic reaction to indomethacin.

The researchers conclude, "our findings suggest a role for increased routine usage of post-ERCP rectal indomethacin and the need for further randomized control trials investigating rectal indomethacin in specific subpopulations of low-risk patients."

Commenting on the findings by email, Dr. B. Joseph Elmunzer of the Medical University of South Carolina in Charleston told Reuters Health, "Although the role of rectal indomethacin for preventing post-ERCP pancreatitis in average-risk patients has been controversial, the findings of this high-quality, real-world effectiveness study are consistent with clinical trial data demonstrating that rectal NSAIDs are effective in both high and average risk cases."

Dr. Elmunzer, who has conducted research in the field, concluded that "these results should have a positive impact on clinical practice by influencing practitioners to more broadly administer this beneficial medication."


Gastroenterol 2016.

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