Role of vitamin C and rectal indomethacin in preventing and alleviating post-endoscopic retrograde cholangiopancreatography pancreatitis: a clinical study
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Background/Aims: This study aimed to determine whether vitamin C in addition to indomethacin decreases the occurrence and severity of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) occurrence and severity. Methods: This randomized clinical trial included patients undergoing ERCP. The participants were administered either rectal indomethacin (100 mg) plus an injection of vitamin C (500 mg) or rectal indomethacin (100 mg) alone just before ERCP. The primary outcomes were PEP occurrence and severity. The secondary amylase and lipase levels were determined after 24 hours. Results: A total of 344 patients completed the study. Based on intention-to-treat analysis, the PEP rates were 9.9% for indomethacin plus vitamin C plus indomethacin and 15.7% for indomethacin alone. Regarding the per-protocol analysis, the PEP rates were 9.7% and 15.7% in the combination and indomethacin arms, respectively. There was a remarkable difference between the two arms in PEP occurrence and severity on intention-to-treat and per-protocol analyses (p=0.034 and p=0.031, respectively). The post-ERCP lipase and amylase concentrations were lower in the combination arm than in the indomethacin alone arm (p=0.034 and p=0.029, respectively). Conclusions: Vitamin C injection in addition to rectal indomethacin reduced PEP occurrence and severity.
Abstract
Background/Aims: This study aimed to determine whether vitamin C in addition to indomethacin decreases the occurrence and severity of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) occurrence and severity. Methods: This randomized clinical trial included patients undergoing ERCP. The participants were administered either rectal indomethacin (100 mg) plus an injection of vitamin C (500 mg) or rectal indomethacin (100 mg) alone just before ERCP. The primary outcomes were PEP occurrence and severity. The secondary amylase and lipase levels were determined after 24 hours. Results: A total of 344 patients completed the study. Based on intention-to-treat analysis, the PEP rates were 9.9% for indomethacin plus vitamin C plus indomethacin and 15.7% for indomethacin alone. Regarding the per-protocol analysis, the PEP rates were 9.7% and 15.7% in the combination and indomethacin arms, respectively. There was a remarkable difference between the two arms in PEP occurrence and severity on intention-to-treat and per-protocol analyses (p=0.034 and p=0.031, respectively). The post-ERCP lipase and amylase concentrations were lower in the combination arm than in the indomethacin alone arm (p=0.034 and p=0.029, respectively). Conclusions: Vitamin C injection in addition to rectal indomethacin reduced PEP occurrence and severity.
참고문헌 (22)
- Pereira P, "Cholangiopancreatoscopy : expanding the diagnostic indications of endoscopic retrograde cholangiopancreatography", J Gastrointestin Liver Dis, 29, pp.445~454 (2020)
- Johnson KD, "Endoscopic retrograde cholangiopancreatography-related complications and their management strategies : a"scoping"literature review", Dig Dis Sci, 65, pp.361~375 (2020)
- Bhatt H, "Post-endoscopic retrograde cholangiopancreatography pancreatitis : an updated review of current preventive strategies", Clin Exp Gastroenterol, 14, pp.27~32 (2021)
- Bozkurt S, "The effects of different mechanisms on the development of post-ERCP pancreatitis in an ERCP model in rats", Turk J Gastroenterol, 24, pp.469~475 (2013)
- Mohammad Alizadeh AH, "Comparison of rectal indomethacin, diclofenac, and naproxen for the prevention of post endoscopic retrograde cholangiopancreatography pancreatitis", Eur J Gastroenterol Hepatol, 29, pp.349~354 (2017)
- Abbasinazari M, "Does allopurinol prevent post endoscopic retrograde cholangio-pancreatography pancreatitis? A randomized double blind trial", Acta Med Iran, 49, pp.579~583 (2011)
- Katsinelos P, "Intravenous N-acetylcysteine does not prevent post-ERCP pancreatitis", Gastrointest Endosc, 62, pp.105~111 (2005)
- Räty S, "Post-ERCP pancreatitis : reduction by routine antibiotics", J Gastrointest Surg, 5, pp.339~345 (2001)
- Hatami B, "Epinephrine in the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis : a preliminary study", Case Rep Gastroenterol, 12, pp.125~136 (2018)
- Dumonceau JM, "ERCP-related adverse events : European Society of Gastrointestinal Endoscopy(ESGE)guideline", Endoscopy, 52, pp.127~149 (2020)
- Bopanna S, "Increased oxidative stress and deficient antioxidant levels may be involved in the pathogenesis of idiopathic recurrent acute pancreatitis", Pancreatology, 17, pp.529~533 (2017)
- Duarte TL, "Review: when is an antioxidant not an antioxidant? A review of novel actions and reactions of vitamin C", Free Radic Res, 39, pp.671~686 (2005)
- Scott P, "Vitamin C status in patients with acute pancreatitis", Br J Surg, 80, pp.750~754 (1993)
- Siriwardena AK, "Randomised, double blind, placebo controlled trial of intravenous antioxidant(n-acetylcysteine, selenium, vitamin C)therapy in severe acute pancreatitis", Gut, 56, pp.1439~1444 (2007)
- Banks PA, "Classification of acute pancreatitis--2012 : revision of the Atlanta classification and definitions by international consensus", Gut, 62, pp.102~111 (2013)
- Cotton PB, "Grading the complexity of endoscopic procedures : results of an ASGE working party", Gastrointest Endosc, 73, pp.868~874 (2011)
- Armstrong JA, "Oxidative stress in acute pancreatitis : lost in translation?", Free Radic Res, 47, pp.917~933 (2013)
- Thiruvengadam NR, "Emerging therapies to prevent post-ERCP pancreatitis", Curr Gastroenterol Rep, 22, pp.59~ (2020)
- Bonham MJ, "Early ascorbic acid depletion is related to the severity of acute pancreatitis", Br J Surg, 86, pp.1296~1301 (1999)
- Mohseni Salehi Monfared SS, "Antioxidant therapy in the management of acute, chronic and post-ERCP pancreatitis : a systematic review", World J Gastroenterol, 15, pp.4481~4490 (2009)
- Gooshe M, "Antioxidant therapy in acute, chronic and post-endoscopic retrograde cholangiopancreatography pancreatitis : an updated systematic review and meta-analysis", World J Gastroenterol, 21, pp.9189~9208 (2015)
- Köseoğlu H, "Risk factors for post-ERCP pancreatitis : it depends on the ERCP indication", Acta Gastroenterol Belg, 83, pp.598~602 (2020)