Is rectal indomethacin effective in preventing of post-endoscopic retrograde cholangiopancreatography pancreatitis?

Table 1 Comparison of the two groups of patients according to patient and investigation characteristics (n = 665) n (%)

Patient and investigation characteristics	Indomethacin group(n = 347)	Control group(n = 318)
Gender
Male (n = 239)	133 (55.64)	106 (44.35)
Female (n = 426)	214 (50.23)	212 (49.76)
Age
< 70 yr (n = 355)	190 (53.52)	165 (46.48)
> 70 yr (n = 310)	157 (50.65)	153 (49.35)
BMI
< 25 (n = 303)	156 (51.48)	147 (48.51)
25-30 (n = 236)	125 (53.96)	111 (47.03)
> 30 (n = 126)	66 (52.38)	60 (47.62)
Duration of ERCP
< 20 min (n = 454)	236 (52.0)	218 (48.0)
> 20 min (n = 211)	111 (52.6)	100 (47.4)
Dilated/non-dilated bile duct
Dilated (n = 366)	189 (51.64)	177 (48.36)
Non-dilated (n = 299)	158 (52.84)	141 (47.15)
Pancreatic duct opacification (n = 463)	246 (53.13)	217 (46.87)
EST
Biliary (n = 443)	224 (50.56)	219 (49.43)
Pancreatic/double (n = 48)	22 (44.0)	28 (56.0)
Difficult cannulation (n = 116)	64 (55.17)	52 (44.83)
Gallstone extraction (n = 165)	82 (49.7)	83 (50.3)
Bile duct dilatation (n = 22)	11 (50.0)	11 (50.0)
Biliary stent placement
Plastic stent (n = 75)	35 (46.7)	40 (53.3)
Metal stent	0	0

BMI: Body mass index; EST: Endoscopic sphincterotomy; ERCP: Endoscopic retrograde cholangiopancreatography.

Table 2 Distribution of specific risk factors in the investigated population (n = 665) n (%)

Risk factors	Indomethacingroup (n = 347)	Control group(n = 318)	P value
Age < 50 yr (n = 104)	57/347 (16.4)	47/318 (14.8)	0.559
Female gender (n = 426)	214/347 (61.7)	212/318 (66.7)	0.180
BMI > 25 (n = 362)	191/347 (55.0)	171/318 (53.8)	0.743
Duration of ERCP > 20 min (n = 211)	111/347 (32.0)	100/318 (31.4)	0.880
Non-dilated bile duct (n = 299)	158/347 (45.5)	141/318 (44.3)	0.757
Pancreatic duct opacification (n = 463)	246/347 (70.1)	217/318 (68.2)	0.534
EST biliary (n = 443)	224/347 (64.6)	219/318 (68.9)	0.195
EST pancreatic/double (n = 48)	20/347 (5.8)	28/318 (8.8)	0.130
Difficult cannulation (n = 116)	64/347 (18.4)	52/318 (16.4)	0.111
Gallstone extraction (n = 165)	82/347 (23.6)	83/318 (26.1)	0.461
Bile duct dilatation (n = 22)	11/347 (3.2)	11/318 (3.5)	0.835
Biliary plastic stent placement (n = 75)	35/347 (10.1)	40/318 (12.6)	0.640
Total (n = 2734)	1413/4164 (33.9)	1321/3816 (34.6)	0.520

BMI: Body mass index; EST: Endoscopic sphincterotomy; ERCP: Endoscopic retrograde cholangiopancreatography.

Table 3 Incidence of post-endoscopic retrograde cholangiopancreatography pancreatitis and hyperamylasaemia (n = 665)

Group of patients	ERCP (n)	Pancreatitis (n)	Pancreatitis	Hyperamylasaemia (n)	Hyperamylasaemia
Indomethacin	347	20 (mild: 16, severe: 4)	5.76%	81	23.34%
Control	318	22 (mild: 18, severe: 4)	6.92%	79	24.84%
Total	665	42	6.32%	160	24.06%

There were no statistically significant differences (P = 0.541 and P = 0.651). ERCP: Endoscopic retrograde cholangiopancreatography.

Table 4 Incidence of post-endoscopic retrograde cholangiopancreatography pancreatitis according to risk factors (n = 665) n (%)

Risk factors	Indomethacingroup	Control group	P value
Age < 50 yr (n = 104)	5/57 (8.77)	6/47 (12.76)	0.365
Female gender (n = 426)	16/214 (7.47)	19/212 (8.96)	0.576
BMI > 25 (n = 362)	12/191 (6.28)	10/171 (5.85)	0.862
Duration of ERCP > 20 min (n = 211)	8/111 (7.2)	7/100 (7.0)	0.580
Non-dilated bile duct (n = 299)	10/158 (6.33)	11/141 (7.8)	1.000
Pancreatic duct opacification (n = 463)	20/246 (8.13)	20/217 (9.21)	0.263
EST biliary (n = 443)	14/224 (6.25)	14/219 (6.4)	0.951
EST pancreatic/double (n = 48)	4/20 (20.0)	5/28 (17.86)	0.560
Difficult cannulation (n = 116)	4/64 (6.25)	6/52 (11.54)	0.478
Gallstone extraction (n = 165)	3/82 (3.66)	5/83 (6.02)	0.451
Bile duct dilatation (n = 22)	1/11 (9.1)	2/11 (18.2)	0.537
Biliary plastic stent placement (n = 75)	4/35 (11.43)	3/40 (7.5)	0.580

There were no statistically significant differences. BMI: Body mass index; EST: Endoscopic sphincterotomy; ERCP: Endoscopic retrograde cholangiopancreatography.