15.EFFICACY OF RECTAL INDOMETHACIN IN PREVENTION OF POST-ERCP PANCREATITIS

Background: Acute pancreatitis is a common and serious complication of endoscopic retrograde cholangiopancreatography (ERCP). Post-ERCP pancreatitis (PEP) accounts for substantial annual morbidity and health care expenditure, and occasional death. The prevention of PEP is an ongoing area of active research. Several proposed pharmacologic agents and therapeutic techniques have been proposed to reduce the risk of PEP. Nonsteroidal antiinflammatory drugs (NSAIDs) reduce incidence of PEP in both high- and low-risk patients. Rectal NSAIDs are among the few agents shown to be effective in preventing PEP. Indomethacin is one of the NSAIDs used in the clinical trials. The objective of this study was to compare the frequency of Post ERCP Pancreatitis in patients treated with or without rectal indomethacin. Methodology:A prospective, randomized controlled study conducted in tertiary care hospital on 300 patients randomized to receive a suppository containing 100 mg indomethacin or no suppositories, just after completion of ERCP. Post-ERCP pancreatitis was evaluated by amylase and lipase levels in patients with epigastric pain, 4 hours after ERCP.Results:In our study, mean age was recorded as 56.28+8.39 in Indomethacin and 55.72+7.84 years in those without Indomethacin group, 55.33%(n=83) in Indomethacin and 53.33%(n=80) in those without Indomethacin group were male while 44.67%(n=67) in Indomethacin and 46.67%(n=70) in those without Indomethacin group were females. Comparison of frequency of Post ERCP Pancreatitis in patients treated with or without rectal indomethacin was done, it shows that 5.33 %( n=8) in Indomethacin and 12.67 %( n=19) in those without Indomethacin group, p value was calculated as 0.02 showing a significant difference between the two groups.Conclusion:We concluded that the frequency of Post ERCP Pancreatitis is significantly lower in patients treated with rectal indomethacin when compared to those without it. Keywords: Post ERCP Pancreatitis, rectal indomethacin