PMID- 32213036
OWN - NLM
STAT- MEDLINE
DCOM- 20210628
LR  - 20210628
IS  - 2050-6414 (Electronic)
IS  - 2050-6406 (Print)
IS  - 2050-6406 (Linking)
VI  - 8
IP  - 4
DP  - 2020 May
TI  - Diclofenac does not reduce the risk of acute pancreatitis in patients with 
      primary sclerosing cholangitis after endoscopic retrograde cholangiography.
PG  - 462-471
LID - 10.1177/2050640620912608 [doi]
AB  - BACKGROUND: The European Society of Gastrointestinal Endoscopy recommends rectal 
      indomethacin or diclofenac before endoscopic retrograde cholangiopancreatography 
      (ERCP) to prevent post-ERCP pancreatitis. However, data on the prophylactic 
      effect in patients with primary sclerosing cholangitis (PSC) are lacking. 
      METHODS: This was a retrospective case-control study. In 2009-2018, a total of 
      2000 ERCPs were performed in 931 patients with PSC. Case procedures (N = 1000 
      after November 2013) were performed after administration of rectal diclofenac. 
      Control procedures (N = 1000 before November 2013) were performed with the same 
      indication but without diclofenac. Acute post-ERCP pancreatitis and other 
      ERCP-related adverse events (AEs) were evaluated. RESULTS: Post-ERCP pancreatitis 
      developed in 49 (4.9%) procedures in the diclofenac group and 62 (6.2%) 
      procedures in the control group (p = 0.241). No difference existed between the 
      groups in terms of the severity of pancreatitis or any other acute AEs. The risk 
      of pancreatitis was elevated in patients with native papilla: 11.4% in the 
      diclofenac group and 8.7% in the control group (p = 0.294). In adjusted logistic 
      regression, diclofenac did not reduce the risk of pancreatitis (odds ratio 
      (OR) = 1.074, 95% confidence interval 0.708-1.629, p = 0.737). However, in 
      generalised estimation equations with the advanced model, diclofenac seemed to 
      diminish the risk of pancreatitis (OR = 0.503) but not significantly (p = 0.110). 
      CONCLUSION: In this large patient cohort in a low-risk unit, diclofenac does not 
      seem to reduce the risk of post-ERCP pancreatitis in patients with PSC. The trend 
      in the pancreatitis rate after ERCP is decreasing. The evaluation of the benefits 
      of diclofenac among PSC patients warrants a randomised controlled study targeted 
      to high-risk patients and procedures.
FAU - Koskensalo, Vilja
AU  - Koskensalo V
AUID- ORCID: 0000-0002-6869-0752
AD  - Faculty of Medicine, University of Helsinki, Helsinki, Finland.
AD  - Abdominal Centre, Gastroenterological Surgery, Helsinki University Hospital, 
      Helsinki, Finland.
FAU - Tenca, Andrea
AU  - Tenca A
AD  - Faculty of Medicine, University of Helsinki, Helsinki, Finland.
AD  - Abdominal Centre, Gastroenterology, Helsinki University Hospital, Helsinki, 
      Finland.
FAU - Udd, Marianne
AU  - Udd M
AD  - Faculty of Medicine, University of Helsinki, Helsinki, Finland.
AD  - Abdominal Centre, Gastroenterological Surgery, Helsinki University Hospital, 
      Helsinki, Finland.
FAU - Lindstrom, Outi
AU  - Lindstrom O
AD  - Faculty of Medicine, University of Helsinki, Helsinki, Finland.
AD  - Abdominal Centre, Gastroenterological Surgery, Helsinki University Hospital, 
      Helsinki, Finland.
FAU - Rainio, Mia
AU  - Rainio M
AD  - Faculty of Medicine, University of Helsinki, Helsinki, Finland.
AD  - Abdominal Centre, Gastroenterological Surgery, Helsinki University Hospital, 
      Helsinki, Finland.
FAU - Jokelainen, Kalle
AU  - Jokelainen K
AD  - Faculty of Medicine, University of Helsinki, Helsinki, Finland.
AD  - Abdominal Centre, Gastroenterology, Helsinki University Hospital, Helsinki, 
      Finland.
FAU - Kylanpaa, Leena
AU  - Kylanpaa L
AD  - Faculty of Medicine, University of Helsinki, Helsinki, Finland.
AD  - Abdominal Centre, Gastroenterological Surgery, Helsinki University Hospital, 
      Helsinki, Finland.
FAU - Farkkila, Martti
AU  - Farkkila M
AD  - Faculty of Medicine, University of Helsinki, Helsinki, Finland.
AD  - Abdominal Centre, Gastroenterology, Helsinki University Hospital, Helsinki, 
      Finland.
LA  - eng
PT  - Journal Article
DEP - 20200308
PL  - England
TA  - United European Gastroenterol J
JT  - United European gastroenterology journal
JID - 101606807
RN  - 0 (Anti-Inflammatory Agents, Non-Steroidal)
RN  - 144O8QL0L1 (Diclofenac)
SB  - IM
MH  - Administration, Rectal
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Anti-Inflammatory Agents, Non-Steroidal/*administration & dosage
MH  - Case-Control Studies
MH  - Cholangiopancreatography, Endoscopic Retrograde
MH  - Cholangitis, Sclerosing/*surgery
MH  - Diclofenac/*administration & dosage
MH  - Feasibility Studies
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Odds Ratio
MH  - Pancreatitis/*epidemiology/etiology/prevention & control
MH  - Postoperative Complications/*epidemiology/etiology/prevention & control
MH  - Retrospective Studies
MH  - Risk Assessment/statistics & numerical data
MH  - Risk Factors
MH  - Treatment Outcome
MH  - Young Adult
PMC - PMC7226698
OTO - NOTNLM
OT  - Primary sclerosing cholangitis
OT  - diclofenac
OT  - post endoscopic retrograde cholangiography pancreatitis
EDAT- 2020/03/28 06:00
MHDA- 2021/06/29 06:00
PMCR- 2020/05/01
CRDT- 2020/03/28 06:00
PHST- 2020/03/28 06:00 [pubmed]
PHST- 2021/06/29 06:00 [medline]
PHST- 2020/03/28 06:00 [entrez]
PHST- 2020/05/01 00:00 [pmc-release]
AID - 10.1177_2050640620912608 [pii]
AID - 10.1177/2050640620912608 [doi]
PST - ppublish
SO  - United European Gastroenterol J. 2020 May;8(4):462-471. doi: 
      10.1177/2050640620912608. Epub 2020 Mar 8.