A nem szteroid gyulladásgátlók néhány eddigi tanulmányban eredményesnek tűntek a poszt-ERCP-s pancreatitis incidenciájának csökkentésében, de az eredmények további megerősítésre szorulnak. Célkitűzés: Rectalis indometacin hatásosságának megítélése az ERCP-t követő pancreatitis gyakoriságának csökkentésében. Módszer: Prospektív, randomizált, placebokontrollált tanulmány. Kétszázhuszonnyolc beteg ERCP előtt 10 perccel randomizáltan kapott 100 mg indometacint vagy placebokúpot. A pancreatitis értékelése a klinikai tünetek és a 24 órás szérumamilázszintek alapján történt. Eredmények: Sem a pancreatitis, sem a hyperamylasaemia gyakoriságában nem volt szignifikáns különbség a két vizsgálati csoport között, jóllehet, az indometacint kapottak közt jóval ritkábban fordult elő pancreatitis, különösen nők, 60 év felettiek és 25-nél kisebb BMI esetén. E tendencia egyáltalán nem érvényesült pancreasvezeték-töltés és pancreas-EST esetén. Következtetések: Az eredmények statisztikailag nem erősítik meg, hogy a rectalisan adott indometacin csökkenti a poszt-ERCP-s pancreatitis gyakoriságát, de az észlelt tendencia az indometacin preventív hatása mellett szólhat. Nagyobb esetszámú multicentrikus tanulmány szükséges az indometacin szerepének biztonságos megítéléséhez. Orv. Hetil., 2012, 153, 990–996.
Freeman, M. L., Guda, M. N.: Prevention of post-ERCP pancreatitis. A comprehensive review. Gastrointest. Endosc., 2004, 59, 845–864.
Guda M. N. , 'Prevention of post-ERCP pancreatitis. A comprehensive review ' (2004 ) 59 Gastrointest. Endosc. : 845 -864 .
Dumonceau, J.-M., Andriulli, A., Deviere, J., et al.: European Society of Gastrointestinal Endoscopy (ESGE) guideline: prophylaxis of post-ERCP pancreatitis. Endoscopy, 2010, 42, 503–515.
Deviere J. , 'European Society of Gastrointestinal Endoscopy (ESGE) guideline: prophylaxis of post-ERCP pancreatitis ' (2010 ) 42 Endoscopy : 503 -515 .
Wagh, M. S., Sherman, S.: Indomethacin for post-ERCP pancreatitis prophylaxis. Another attempt at holy grail. Am. J. Gastroenterol., 2007, 102, 984–986.
Sherman S. , 'Indomethacin for post-ERCP pancreatitis prophylaxis. Another attempt at holy grail ' (2007 ) 102 Am. J. Gastroenterol. : 984 -986 .
Senol, A., Ulku, S., Halil, D.: Efficacy of intramuscular diclofenac and fluid replacement in prevention of post-ERCP pancreatitis. World J. Gastroenterol., 2009, 15, 3999–4004.
Halil D. , 'Efficacy of intramuscular diclofenac and fluid replacement in prevention of post-ERCP pancreatitis ' (2009 ) 15 World J. Gastroenterol. : 3999 -4004 .
Rabenstein, T., Hahn, E. G.: Post-ERCP pancreatitis. New momentum. Endoscopy, 2002, 34, 325–329.
Hahn E. G. , 'Post-ERCP pancreatitis. New momentum ' (2002 ) 34 Endoscopy : 325 -329 .
Döbrönte, Z.: Endoscopic retrograde cholangiopancreatography (ERCP) related acute pancreatitis. In: Acute pancreatitis. Ed.: Rodrigo, L. InTech, Rijeka, 2011, 197–214.
Döbrönte Z. , '', in Acute pancreatitis , (2011 ) -.
Lankisch, P. K., Koop, H., Winckler, K., et al.: Indomethacin treatment of acute experimental pancreatitis in the rat. Scand. J. Gastroenterol., 1978, 13, 629–633.
Winckler K. , 'Indomethacin treatment of acute experimental pancreatitis in the rat ' (1978 ) 13 Scand. J. Gastroenterol. : 629 -633 .
Wildenhain, P. M., Melhem, M. F., Birsic, W. I., et al.: Acute hemorrhagic pancreatitis in mice: improved survival after indomethacin administration. Digestion, 1989, 44, 41–51.
Birsic W. I. , 'Acute hemorrhagic pancreatitis in mice: improved survival after indomethacin administration ' (1989 ) 44 Digestion : 41 -51 .
Murray, B., Carter, R., Imrie, C., et al.: Indomethacin may reduce the incidence of acute pancreatitis after endoscopic retrograde cholangiopancreatography. Gastroenterology, 2003, 124, 1786–1791.
Imrie C. , 'Indomethacin may reduce the incidence of acute pancreatitis after endoscopic retrograde cholangiopancreatography ' (2003 ) 124 Gastroenterology : 1786 -1791 .
Sotoudehmanesh, R., Khatibian, M., Kolahdoozan, S., et al.: Diclofenac reduces the incidence and severity of acute pancreatitis after ERCP. Am. J. Gastroenterol., 2007, 102, 978–983.
Kolahdoozan S. , 'Diclofenac reduces the incidence and severity of acute pancreatitis after ERCP ' (2007 ) 102 Am. J. Gastroenterol. : 978 -983 .
Koshbaten, M., Khorram, H., Madad, L., et al.: Role of diclofenac in reducing post-endoscopic retrograde cholangiopancreatography pancreatitis. J. Gastroenterol. Hepatol., 2008, 23, e11–e16.
Madad L. , 'Role of diclofenac in reducing post-endoscopic retrograde cholangiopancreatography pancreatitis ' (2008 ) 23 J. Gastroenterol. Hepatol. : e11 -e16 .
Montano Loza, A., Garcia Correa, J., Gonzales Ojeda, A., et al.: Effect of administration of rectal indomethacin on amylase serum levels after endoscopic retrograde cholangiopancreatography, and its impact on the development of secundary pancreatitis episodes. Rev. Esp. Enferm. Dig., 2007, 99, 330–336.
Gonzales Ojeda A. , 'Effect of administration of rectal indomethacin on amylase serum levels after endoscopic retrograde cholangiopancreatography, and its impact on the development of secundary pancreatitis episodes ' (2007 ) 99 Rev. Esp. Enferm. Dig. : 330 -336 .
Elmunzer, B. J., Waljee, A. K., Elta, G. H., et al.: A meta-analysis of rectal NSAIDs in the prevention of post-ERCP pancreatitis. Gut, 2008, 57, 1262–1267.
Elta G. H. , 'A meta-analysis of rectal NSAIDs in the prevention of post-ERCP pancreatitis ' (2008 ) 57 Gut : 1262 -1267 .
Zhang, M.-H., Xia, H., Chen, Y.-P.: Rectal administration of NSAIDs in prevention of post-ERCP pancreatitis: a complementary meta-analysis. Gut, 2008, 57, 1632–1633.
Chen Y.-P. , 'Rectal administration of NSAIDs in prevention of post-ERCP pancreatitis: a complementary meta-analysis ' (2008 ) 57 Gut : 1632 -1633 .
Dai, H.-F., Wang, X.-W, Zhao, K.: Role of nonsteroideal anti-inflammatory drugs in prevention of post-ERCP pancreatitis: a meta-analysis. Hepatobiliary Pancreat. Dis. Int., 2009, 8, 11–16.
Zhao K. , 'Role of nonsteroideal anti-inflammatory drugs in prevention of post-ERCP pancreatitis: a meta-analysis ' (2009 ) 8 Hepatobiliary Pancreat. Dis. Int. : 11 -16 .
Dumonceau, J. M., Rigaux, J., Kahaleh, M., et al.: Prophylaxis of post-ERCP pancreatitis: a practice survey. Gastrointest. Endosc., 2010, 71, 934–939.
Kahaleh M. , 'Prophylaxis of post-ERCP pancreatitis: a practice survey ' (2010 ) 71 Gastrointest. Endosc. : 934 -939 .
Dumonceau, J. M.: Endoscopy essentials. Biliary endoscopic retrograde cholangiopancreatography. Endoscopy, 2010, 42, 58–61.
Dumonceau J. M. , 'Endoscopy essentials. Biliary endoscopic retrograde cholangiopancreatography ' (2010 ) 42 Endoscopy : 58 -61 .
Cotton, P. B., Lehman, G., Vennes, J., et al.: Endoscopic sphincterotomy complications and their management: An attempt at consensus. Gastrointest. Endosc., 1991, 37, 383–393.
Vennes J. , 'Endoscopic sphincterotomy complications and their management: An attempt at consensus ' (1991 ) 37 Gastrointest. Endosc. : 383 -393 .
Andrulli, A., Forlano, B., Napolitano, G., et al.: Pancreatic duct stents in the prophylaxis of pancreatic damage after endoscopic retrograde cholangiopancreatography: a systematic analysis of benefits and associated risks. Digestion, 2007, 75, 156–163.
Napolitano G. , 'Pancreatic duct stents in the prophylaxis of pancreatic damage after endoscopic retrograde cholangiopancreatography: a systematic analysis of benefits and associated risks ' (2007 ) 75 Digestion : 156 -163 .
Singh, P., Das, A., Isenberg, G., et al.: Does prophylactic pancreatic stent placement reduce the risk of post-ERCP acute pancreatitis? A meta-analysis of controlled trials. Gastrointest. Endosc., 2004, 60, 544–550.
Isenberg G. , 'Does prophylactic pancreatic stent placement reduce the risk of post-ERCP acute pancreatitis? A meta-analysis of controlled trials ' (2004 ) 60 Gastrointest. Endosc. : 544 -550 .
Sofuni, A., Maguchi, H., Itoi, T., et al.: Prophylaxis of post-endoscopic retrograde cholangiopancreatography pancreatitis by an endoscopic pancreatic spontaneous dislodgement stent. Clin. Gastroenterol. Hepatol., 2007, 5, 1339–1346.
Itoi T. , 'Prophylaxis of post-endoscopic retrograde cholangiopancreatography pancreatitis by an endoscopic pancreatic spontaneous dislodgement stent ' (2007 ) 5 Clin. Gastroenterol. Hepatol. : 1339 -1346 .
Freeman, M. L., Overby, C., Qi, D.: Pancreatic stent insertion: consequences of failure and results of a modified technique to maximize success. Gastrointest. Endosc., 2004, 59, 8–14.
Qi D. , 'Pancreatic stent insertion: consequences of failure and results of a modified technique to maximize success ' (2004 ) 59 Gastrointest. Endosc. : 8 -14 .
Das, A., Singh, P., Sivak, M. V., et al.: Pancreatic stent-placement for prevention of post-ERCP pancreatitis: a cost-effectiveness analysis. Gastrointest. Endosc., 2007, 65, 960–968.
Sivak M. V. , 'Pancreatic stent-placement for prevention of post-ERCP pancreatitis: a cost-effectiveness analysis ' (2007 ) 65 Gastrointest. Endosc. : 960 -968 .
Cheon, Y. K., Cho, K. B., Watkins, J. L., et al.: Efficacy of diclofenac in prevention of post-ERCP pancreatitis in predominantly high risk patients: a randomised double-blind prospective trial. Gastrointest. Endosc., 2007, 66, 1126–1132.
Watkins J. L. , 'Efficacy of diclofenac in prevention of post-ERCP pancreatitis in predominantly high risk patients: a randomised double-blind prospective trial ' (2007 ) 66 Gastrointest. Endosc. : 1126 -1132 .
Wang, P., Li, Z.-S., Liu, F., et al.: Risk factors for ERCP related complications: a prospective multicenter study. Am. J. Gastroenterol., 2009, 104, 31–40.
Liu F. , 'Risk factors for ERCP related complications: a prospective multicenter study ' (2009 ) 104 Am. J. Gastroenterol. : 31 -40 .
Katsinelos, P., Fasoulas, K., Paroutoglou, G., et al.: Combination of diclofenac plus somatostatin in the prevention of post-ERCP pancreatitis: a randomised, double-blind, placebo-controlled trial. Endoscopy, 2012, 44, 53–59.
Paroutoglou G. , 'Combination of diclofenac plus somatostatin in the prevention of post-ERCP pancreatitis: a randomised, double-blind, placebo-controlled trial ' (2012 ) 44 Endoscopy : 53 -59 .