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For lowering the risk of developing post-ERCP pancreatitis, pharmacological prophylaxis is an excellent alternative to mechanical stenting.
A narrative review has reported that the utilization of rectal non-steroidal anti-inflammatory drugs (NSAIDs) either on their own or in conjunction with intravenous hydration and sublingual nitrate administration resulted in a significant decrease in the occurrence of pancreatitis. Additionally, the stent placement was found to be on par with pharmacological interventions.
The investigators sought to explore strategies for preventing post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis and assess the effectiveness of both non-pharmacological and pharmacological interventions. The search for articles on Pubmed utilized the keywords "post-ERCP" and "pancreatitis". The inclusion criteria encompassed randomized controlled trials involving volunteers who had undergone ERCP for any medical condition and evaluated the effectiveness of non-pharmacological or pharmacological interventions.
The search considered studies published within the past seven years while excluding observational studies, descriptive studies, reviews, and studies with limited access. The major endpoint was assessing the occurrence of post-ERCP pancreatitis. Among the interventions studied, NSAIDs were identified as the most efficacious drugs for decreasing pancreatitis incidence, with the rectal route being the preferred administration method.
Following NSAIDs, intravenous hydration and sublingual nitrate exhibited favorable results, particularly when used in conjunction with rectal NSAIDs. While drugs such as Nafamostat mesilate and Magnesium sulfate did show a decline in occurrence, the outcomes did not reach statistical significance. Epinephrine spray applied to the duodenal papilla did not yield any benefits and even posed a potential risk of elevating the occurrence.
Additionally, stent placement proved effective in reducing the prevalence of pancreatitis. The utilization of rectal NSAIDs either as a standalone treatment or in combination with sublingual nitrate and intravenous hydration resulted in a significant decrease in pancreatitis incidence. Furthermore, stent placement exhibited similar effectiveness to pharmacological interventions. Consequently, the consistent adoption of pharmacological interventions prior to the procedure can serve as a valuable strategy for mitigating the risk of this serious complication.
Journal of Pancreatology
Pharmacological and Non-pharmacological Prophylaxis in the Prevention of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis; A Narrative Review
Amina Ehsan
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