Less post-ERCP pancreatitis with lactated Ringer's plus rectal indomethacin

Last Updated: 2016-11-30

By Reuters Staff

NEW YORK (Reuters Health) - Infusion of lactated Ringer's solution along with rectal administration of indomethacin was associated with lower rates of post-ERCP pancreatitis (PEP) in a randomized, placebo-controlled trial.

Pancreatitis follows ERCP in as many as 10% of low-risk individuals and up to 30% of high-risk individuals, resulting in significant morbidity and medical costs. Various pharmacological agents have been studied for prophylaxis, with mixed results.

Dr. Shaffer R. S. Mok and colleagues from Cooper Medical School of Rowan University, Mount Laurel, New Jersey evaluated the use of rectal indomethacin with lactated Ringer's (LR) infusion, compared with placebo, to prevent PEP in their randomized trial of 192 patients undergoing ERCP who were deemed at high risk for it.

The incidence of PEP was 6% with LR plus indomethacin, 13% with normal saline plus indomethacin, 19% with LR plus placebo, and 21% with normal saline plus placebo, the authors reported online November 2nd in Gastrointestinal Endoscopy.

Treatment with LR plus indomethacin was associated with an absolute risk reduction of 14.6% (compared with normal saline and placebo) and a number needed to treat of 6.9 patients to avoid one episode of PEP.

Readmission rates were significantly lower with LR plus indomethacin (2%) than with normal saline plus placebo (13%).

Adverse events were uncommon and included one case of severe acute pancreatitis in the normal saline plus indomethacin group, one case of pancreatitis leading to pseudocyst in the LR plus indomethacin group, and one case of acute renal failure in each study group.

"This randomized, double-blinded, placebo controlled trial suggests that LR infusion plus rectal indomethacin can reduce the incidence of post-ERCP pancreatitis and post-procedure readmission compared with normal saline plus placebo in high-risk patients," the researchers conclude.

Dr. Mok did not respond to a request for comments.

SOURCE: http://bit.ly/2g7vQYk

Gastrointestinal Endoscopy 2016.