Abstract：
BACKGROUND: Rectal indomethacin reduces pancreatitis following endoscopic retrograde cholangiopancreatography (ERCP). However, there is insufficient evidence regarding its added benefits in patients already receiving prophylactic pancreatic stenting. Our goal was to evaluate the impact of indomethacin in high-risk patients undergoing pancreatic stenting.
METHODS: A cohort study was conducted on all patients who underwent the rescue cannulation technique for challenging bile duct cannulation (selected high-risk patients). Patients were split into two groups based on the prophylaxis method for post-ERCP pancreatitis (PEP): one receiving a combination of indomethacin and pancreatic stenting, while the other received pancreatic stenting alone. Comparative analyses were carried out on PEP, hyperamylasemia, gastrointestinal bleeding, and postoperative hospital stay among post-ERCP pancreatitis patients.
RESULTS: Between November 2017 and May 2023, a total of 607 patients with native papillae were enrolled, with 140 grouped into the indomethacin plus stent group and 467 into the stent alone group. The overall PEP rate was 4.4% in the entire cohort, with no statistical differences observed between the groups in terms of PEP rates (P = 0.407), mild PEP (P = 0.340), moderate to severe PEP (P = 1.000), hyperamylasemia (P = 0.543), gastrointestinal bleeding (P = 0.392), and postoperative hospital stay (P = 0.521). Furthermore, sensitivity analysis using multivariable analysis also validated these findings.
CONCLUSIONS: Indomethacin did not reduce the incidence or severity of PEP in high-risk patients who routinely received prophylactic pancreatic stent placement. Therefore, the additional administration of rectal indomethacin to further mitigate PEP appears to be not necessary.
METHODS: A cohort study was conducted on all patients who underwent the rescue cannulation technique for challenging bile duct cannulation (selected high-risk patients). Patients were split into two groups based on the prophylaxis method for post-ERCP pancreatitis (PEP): one receiving a combination of indomethacin and pancreatic stenting, while the other received pancreatic stenting alone. Comparative analyses were carried out on PEP, hyperamylasemia, gastrointestinal bleeding, and postoperative hospital stay among post-ERCP pancreatitis patients.
RESULTS: Between November 2017 and May 2023, a total of 607 patients with native papillae were enrolled, with 140 grouped into the indomethacin plus stent group and 467 into the stent alone group. The overall PEP rate was 4.4% in the entire cohort, with no statistical differences observed between the groups in terms of PEP rates (P = 0.407), mild PEP (P = 0.340), moderate to severe PEP (P = 1.000), hyperamylasemia (P = 0.543), gastrointestinal bleeding (P = 0.392), and postoperative hospital stay (P = 0.521). Furthermore, sensitivity analysis using multivariable analysis also validated these findings.
CONCLUSIONS: Indomethacin did not reduce the incidence or severity of PEP in high-risk patients who routinely received prophylactic pancreatic stent placement. Therefore, the additional administration of rectal indomethacin to further mitigate PEP appears to be not necessary.
摘要：
背景：直肠吲哚美辛减少了内镜逆行胰胆管造影术（ERCP）后的胰腺炎。然而,对于已经接受预防性胰腺支架置入术的患者,没有足够的证据证明其额外获益.我们的目标是评估吲哚美辛对接受胰腺支架置入术的高危患者的影响。
方法：对所有接受有挑战性胆管插管的抢救插管技术的患者（选定的高危患者）进行队列研究。根据ERCP后胰腺炎（PEP）的预防方法将患者分为两组：一组接受吲哚美辛和胰腺支架置入术的组合，而另一个单独接受胰腺支架置入术。对PEP进行了比较分析，高淀粉酶血症,消化道出血,和ERCP术后胰腺炎患者的术后住院时间。
结果：在2017年11月至2023年5月期间，共纳入607例天然乳头患者，140分为吲哚美辛加支架组，467分为单独支架组。整个队列的总PEP率为4.4%，两组之间在PEP率方面没有观察到统计学差异（P=0.407），轻度PEP（P=0.340），中度至重度PEP（P=1.000），高淀粉酶血症（P=0.543），消化道出血（P=0.392），术后住院时间(P=0.521)。此外，使用多变量分析的敏感性分析也验证了这些发现。
结论：吲哚美辛不能降低常规接受预防性胰腺支架置入术的高危患者PEP的发生率或严重程度。因此,似乎没有必要额外直肠给药吲哚美辛以进一步缓解PEP.
方法：对所有接受有挑战性胆管插管的抢救插管技术的患者（选定的高危患者）进行队列研究。根据ERCP后胰腺炎（PEP）的预防方法将患者分为两组：一组接受吲哚美辛和胰腺支架置入术的组合，而另一个单独接受胰腺支架置入术。对PEP进行了比较分析，高淀粉酶血症,消化道出血,和ERCP术后胰腺炎患者的术后住院时间。
结果：在2017年11月至2023年5月期间，共纳入607例天然乳头患者，140分为吲哚美辛加支架组，467分为单独支架组。整个队列的总PEP率为4.4%，两组之间在PEP率方面没有观察到统计学差异（P=0.407），轻度PEP（P=0.340），中度至重度PEP（P=1.000），高淀粉酶血症（P=0.543），消化道出血（P=0.392），术后住院时间(P=0.521)。此外，使用多变量分析的敏感性分析也验证了这些发现。
结论：吲哚美辛不能降低常规接受预防性胰腺支架置入术的高危患者PEP的发生率或严重程度。因此,似乎没有必要额外直肠给药吲哚美辛以进一步缓解PEP.
