Rectal indomethacin reduces post-procedural pancreatitis
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Pre-procedural rectal indomethacin administration safely and effectively reduced the incidence of post-extracorporeal shock wave lithotripsy pancreatitis compared with placebo, according to research.
“Pancreatic extracorporeal shock wave lithotripsy (ESWL), usually followed by endoscopic extraction (endoscopic retrograde cholangiopancreatography) of stone fragments, is recommended as a first-line treatment for larger, radiopaque stones obstructing the main pancreatic duct,” Yang-Yang Qian, MD, of the Digestive Endoscopy Center at the Changhai Hospital in Shanghai, and colleagues wrote in The Lancet Gastroenterology & Hepatology. “High-quality studies focusing on the prevention of post-ERCP pancreatitis have been done, with rectal administration of NSAIDs being recommended as effective prophylaxis in international guidelines. However, there has been little research into the incidence of post-ESWL complications and no prophylactic measures have been shown to be effective for post-ESWL complications.”
Seeking to assess the efficacy of prophylactic measures on post-ESWL pancreatitis, researchers enrolled 1,370 patients, aged 18 years and older with chronic pancreatitis and pancreatic stones, into a double-blind, placebo-controlled trial at Changhai Hospital. Patients received either 100 mg rectal indomethacin (685) or identical glycerin suppositories (685) 30 minutes prior to ESWL. The primary studied outcome was the incidence of post-ESWL pancreatitis within 24 hours of the procedure; secondary outcomes included post-ESWL pancreatitis severity, incidence of additional complications and transient adverse events assessed 1-month post-procedure.
According to study results, 9% of patients in the study group experienced complications compared with 14% of patients in the control group (RR = 0.66; 95% CI, 0.49-0.88); post-ESWL pancreatitis occurred in 9% and 12% of patients, respectively (RR = 0.71; 95% CI, 0.52-0.98). Further, transient adverse events occurred in 34% and 37% of patients; asymptomatic hyperamylasemia was the most common adverse event (28% vs. 29%).
“Pre-procedural administration of rectal indomethacin is safe and effective in reducing the incidence of post-ESWL pancreatitis compared with placebo,” Qian and colleagues concluded. “Rectal indomethacin may offer greater prophylactic effect in women and those with idiopathic chronic pancreatitis, pancreas divisum, non-type 3c diabetes and intact exocrine pancreatic function, although the effectiveness of rectal indomethacin in higher risk patients needs further validation.”
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