Abstract
Background: Post endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis is the crucial complications affect about 3.5-30% depend on patients and procedure factors. There are many well established preventive strategies such as the rectal NSAIDs, aggressive intravenous hydration and pancreatic stent placement. Unfortunately the rectal NSAIDs is not available in many countries including Thailand. We aim to evaluation the efficacy of intravenous parecoxib to incidence of post ERCP pancreatitis, hyperamylasemia and clinical significant post ERCP abdominal pain.
Methods: This study performed prospective, double blind, randomized controlled trial in patients who underwent first experienced therapeutic ERCP procedure (native papilla). This report is preliminary data, which was performed between January 2022 and October 2023. The ERCP were performed according to indications and the discretion of experienced endoscopists; data pertaining to patient’s characteristics, serum bilirubin level, procedural technique, cannulation time, type of Ampulla of Vater and endoscopic risk factors were obtained. The incidence of Post ERCP pancreatitis, hyperamylasemia and abdominal pain were compared between the parecoxib plus standard IV hydration and standard IV hydration group.
Results: A total of 85 patients (Parecoxib, n = 43; Control, n = 42) underwent therapeutic ERCP. The mean age was 64 (54,71) years and 44 (51.8%) were male. The American Society of Anesthesiologists classification, presence of comorbid disease, and initial laboratory results were not significantly different between the two groups. The indication for ERCP was common bile duct stone (55.3%) and periampullary cancer (27.1%) respectively. Most of them comprise in a single risk factor account for 43.5% in both groups. The incidence of post-ERCP pancreatitis was 4.7% in the parecoxib group while 11.9% in the standard IV group (p=0.265) and post-ERCP abdominal pain at 4 hours and 24 hours were 34.9% and 9.3% in parecoxib group which was significant lesser than 66.7% and 24.7% (p=0.002) in the control group. Only one patient developed severe necrotizing pancreatitis and underwent necrosectomy.
Conclusions: The intravenous parecoxib plus standard hydration seem to prevent post ERCP pancreatitis compare to the standard hydration. Moreover, the intravenous parecoxib illustrated the clearly benefit in post-procedure related abdominal pain in both 4 and 24 hours respectively without serious adverse events.
Keywords: Parecoxib, Post ERCP pancreatitis, Hyperamylasemia

Thanawin Wong

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