Rectal NSAID Cuts Pancreatitis Risk After ERCP

Post-procedural pancreatitis occurred significantly less often in patients who received rectal indomethacin following endoscopic retrograde cholangiopancreatography (ERCP), results of a large randomized trial showed.

A single post-ERCP dose of indomethacin was associated with a 45% reduction in the incidence of pancreatitis, including 50% fewer cases of moderate or severe pancreatitis.

The benefit was consistent across patient risk categories, although higher-risk patients tended to benefit more often, as reported in the April 12 New England Journal of Medicine.

"Our findings showed that one dose of rectal indomethacin given immediately after ERCP significantly reduced the incidence of post-ERCP pancreatitis in patients at elevated risk for this complication," B. Joseph Elmunzer, MD, of the University of Michigan Medical Center in Ann Arbor, and colleagues wrote.

"Moreover, we found that prophylactic indomethacin decreased the severity of post-ERCP pancreatitis and was associated with a shorter hospital stay. In this trial, the number of high-risk ERCP patients who would need to be treated to prevent one episode of pancreatitis was 13."

Acute pancreatitis

Acute pancreatitis is a sudden inflammation that occurs over a short period of time. In the majority of cases, acute pancreatitis is caused by gallstones or heavy alcohol use. Other causes include medications, infections, trauma, metabolic disorders, and surgery. In about 10% to 15% of people with acute pancreatitis, the cause is unknown.

The severity of acute pancreatitis may range from mild abdominal discomfort to a severe, life-threatening illness. However, the majority of people with acute pancreatitis (more than 80%) recover completely after receiving the appropriate treatment.

In very severe cases, acute pancreatitis can result in bleeding into the gland, serious tissue damage, infection, and cyst formation. Severe pancreatitis can also create conditions which can harm other vital organs such as the heart, lungs, and kidneys.

Post-ERCP pancreatitis adds an estimated $150 million annually to healthcare costs in the U.S. Studies of about three dozen drugs for post-ERCP prophylaxis have failed to demonstrate consistent efficacy, the authors noted in their introduction. Consequently, prophylaxis after ERCP is not widely practiced.

Chronic pancreatitis

Chronic pancreatitis occurs most commonly after an episode of acute pancreatitis and is the result of ongoing inflammation of the pancreas.

In about 45% of people, chronic pancreatitis is caused by prolonged alcohol use. Other causes include gallstones, hereditary disorders of the pancreas, cystic fibrosis, high triglycerides, and certain medicines. Damage to the pancreas from excessive alcohol use may not cause symptoms for many years, but then the person may suddenly develop severe pancreatitis symptoms, including severe pain and loss of pancreatic function, resulting in digestion and blood sugar abnormalities.