Area Editoriale
OBJECTIVES:Acute pancreatitis is the most common complication of endoscopic retrogradecholangiopancreatography (ERCP). Many medications have been used to preventthis complication. We aimed to evaluate the efficacy of rectally administeredindomethacin for the prevention of post-ERCP pancreatitis. METHODS: During 18months, all eligible patients who underwent ERCP were enrolled in this study.In a double-blind randomized trial, patients received a suppository containingindomethacin, 100 mg, or an inert placebo immediately before ERCP. Serumamylase levels and clinically pertinent evaluations were measured in allpatients after ERCP. RESULTS: A total of 490 patients entered the trial, ofwhich half received indomethacin. Twenty-two patients developed pancreatitis;seven cases in the indomethacin group and 15 in the placebo group (P= 0.06).Pancreatic duct injection (OR = 3.0, 95% CI: 1.3-7.4), pancreatic ductcannulation more than once (OR = 4.2, 95% CI: 1.7-10.0), and age less than 60yr (OR = 2.7, 95% CI: 1.0-7.1) were shown to be significant risk factors fordeveloping post-ERCP pancreatitis. In patients who underwent pancreatographywith or without cholangiography, the risk of pancreatitis was significantlylower in the indomethacin group compared with the control group (P= 0.01, RRR =88%, ARR = 0.16, NNT = 6). Moderate to severe pancreatitis was significantlyhigher in the placebo group (P= 0.03). CONCLUSIONS: This trial shows thatrectal indomethacin given immediately before ERCP can reduce the incidence andseverity of post-ERCP pancreatitis. Leggil'articolo