Evaluation of pancreatic stent and/or suppository indomethacin efficacy in post ERCP pancreatitis prophylaxis: a single center experience

Abstract

Aim: Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is a serious complication of ERCP. In this study, we aimed to compare the use of rectal indomethacin, pancreatic stenting or both techniques for prevention of PEP. Material and Method: Patients who underwent ERCP for the first time due to choledocholithiasis between January 2022 and June 2022 were retrospectively reviewed. The clinical findings, demographics, laboratory records, endoscopic intervention characteristics, whether rectal indomethacin was applied before the procedure, whether pancreatic stent was placed or not were evaluated. Results: A total of 367 patients who underwent ERCP for the first time were included in the study. The mean age was 61 (28-92) years and 53.4% were female. In 124 (33.8%) patients, involuntary guide-wire insertion into the pancreatic duct occurred during canulation. Pancreatic stent was placed in 82 (22.3%) of the patients. Rectal indomethacin was administered to 288 patients (78.5%), while indomethacin could not be administered in 79 patients (21.5%), because they did not give consent. When patients with involuntarily pancreatic canulation were evaluated, the rate of PEP was 3.6% in the stented group, while it was 15.3% in the stent-free group (p<0001). The incidence of PEP was 20.3% in 79 patients who could not be administered rectal indomethacin, while this rate was 3.1% in those who received rectal indomethacin (p<0001). Conclusion: The first and most important way to prevent PEP is to avoid unnecessary ERCPs. Rectal indomethacin administration reduces the risk of PEP. All patients with involuntary wires in the pancreatic duct, should be evaluated for pancreatic stent placement.

Keywords

• Post-ERCP pancreatitis
• rectal indomethacin
• pancreatic stent
• prophlaxis

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