The researchers determined whether diclofenac could reduce the incidence or severity of post-ERCP acute pancreatitis.
They published their findings in the latest issue of the British Journal of Surgery.
Entry into the trial was restricted to patients who underwent retrograde pancreatography or with manometrically verified sphincter of Oddi hypertension (n = 200). This was to maximize the incidence of pancreatitis.
After endoscopy, a suppository containing either 100 mg of diclofenac (n = 100) or a placebo (n = 100) was administered.
Serum amylase and clinical parameters were checked at 2 and 24 hours.
The internationally accepted definition of acute pancreatitis was observed throughout the study.
The two groups were well matched for factors that might increase the risk of post-ERCP acute pancreatitis.
A total of 23 patients developed acute pancreatitis (12%), of whom 7 (4%) received rectal diclofenac and 16 (8%) a placebo.
|Acute pancreatitis incidence:|
| British Journal of Surgery |
Some 6 patients with sphincter of Oddi hypertension developed acute pancreatitis, 3 in each group.
Excluding sphincter of Oddi hypertension patients, the incidence of pancreatitis fell to 2% in the diclofenac group and 7% in the placebo group.
The investigators found that 2 of 23 patients developed severe pancreatitis. Both of these patients were in the control group.
There was no mortality, and all patients were discharged home.
The average inpatient stay for patients who developed acute pancreatitis was 3 days for the diclofenac group and 5 days for the control group.
Researcher C. B. Ó. Súilleabháin, of the Glasgow Royal Infirmary, concluded on behalf of fellow authors, "This trial suggests that rectal diclofenac, given immediately after ERCP, reduces the incidence, hospital stay, and severity of pancreatitis in higher risk patients without sphincter of Oddi hypertension."