git j club endoscopy dec 2014
TRANSCRIPT
Endoscopy
articlEs
Eight RCTs &several meta-analyses demonstrated that rectal (NSAIDs) reduce the risk of (PEP) by about 50%.
Rectal indomethacin/ diclofenac also reduce the severity of PEP, effective in both high& average-risk cases
It is grade A recommendation by the European Society of GIE for almost all patients undergoing ERCP.
Although the uptake in clinical practice has been rapid & widespread, there does appear to be some apprehension surrounding the rectal mode of administration.
Rectal administration is unappealing to some healthcare providers &may be undesirable to certain patients. NSAID suppositories are not available on many hospitals, challenging to obtain& marginally more expensive than their parenteral counterparts. Based on available RCT data, only rectal indomethacin or diclofenac should be prescribed for PEP prevention, as recommended by existing guidelines