[Effect of the administration of rectal indomethacin on amylase serum levels after endoscopic retrograde cholangiopancreatography, and its impact on the development of secondary pancreatitis episodes].
BACKGROUND
Hyperamylasemia and acute pancreatitis represent the most frequent major complication after endoscopic retrograde cholangiopancreatography (ERCP), developing in 1-30% of cases.


OBJECTIVE
To determine the incidence of hyperamylasemia and acute pancreatitis after ERCP, and to assess the utility of rectal indomethacin to prevent these events.


METHODS
A randomized clinical trial. During a 12-month period 150 patients were included. They were divided up into a study group (n = 75), where 100 mg of rectal indomethacin were administered 2 hours prior to the procedure, and a control group (n = 75), which received rectal glycerin. Two hours after ERCP serum amylase levels were measured and classified as follows: 0<or=150 IU/L, 1 = 151-599 IU/L, 2>or=600 IU/L. Clinical pancreatitis episodes were quantified and classified according to Ranson's criteria.


RESULTS
Gender distribution: 100 women and 50 men. Mean age: 55.37 +/- 18.0 for the study group, and 51.1 +/- 17.0 for the control group. A diagnosis of benign pathology was present in 56 (74.7%) cases in the study group, and 59 (78.7%) controls. After ERCP 13 (17.3%) patients in the study group and 28 (37.3%) in the control group developed hyperamylasemia (p (2) 0.05). Hyperamylasemia > 600 IU/L was found in 3 patients in the study group, and in 10 in the control group (p = 0.001). Mild pancreatitis was detected in 4 (5.3%) patients in the study group, and in 12 (16%) patients in the control group (p = 0.034). There were no deaths or adverse drug reactions.


CONCLUSIONS
Rectal indomethacin before ERCP decreases the risk of hyperamylasemia and pancreatitis. Indomethacine is a feasible, low-cost drug with minimal or nil side effects.
Montaño Loza
A
A
Departamentos de Gastroenterología y Endoscopia, UMAE, Hospital de Especialidades, CMNO-IMSS, Guadalajara, Jalisco, México.
Rodríguez Lomelí
X
X
García Correa
J E
JE
Dávalos Cobián
C
C
Cervantes Guevara
G
G
Medrano Muñoz
F
F
Fuentes Orozco
C
C
González Ojeda
A
A
D000208:Acute Disease; D000285:Administration, Rectal; D000328:Adult; D000368:Aged; D000681:Amylases / Q000097:blood*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000627:therapeutic use*; D001660:Biliary Tract Diseases / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D015415:Biomarkers; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007213:Indomethacin / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D011292:Premedication; D016037:Single-Blind Method
D000894:Anti-Inflammatory Agents, Non-Steroidal; D015415:Biomarkers; D000681:Amylases; D007213:Indomethacin