title: Pancreatic Stent or Rectal Indomethacin-Which Better Prevents Post-ERCP Pancreatitis?: A Propensity Score Matching Analysis.
abstract: We investigated and compared 2 clinical strategies to prevent postendoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP).We retrospectively reviewed data from patients who underwent ERCP between 2008 and 2014. Of 623 patients at high risk for PEP, 145 were treated with prophylactic pancreatic stent placement (PSP) only, and 478 were treated with rectal indomethacin (RI) only, for PEP prevention. Patients were matched by one-to-one propensity score matching (PSM) by risk factors, with overall PEP incidence as primary outcome, and moderate or severe PEP and complication rates as secondary outcomes.Of 623 patients with high-risk factors, 145 pairs were generated after PSM. Thirty-two patients developed pancreatitis-10 (6.9 %) in the PSP group and 22 (15.2 %) in the RI group (P = 0.025). Moderate-to-severe pancreatitis developed in 5 patients (2.8%) in the PSP group and 14 patients (9.7 %) in the RI group (P = 0.047).Although indomethacin represents an easy, inexpensive treatment, prophylactic PSP is still the better prevention strategy for PEP.
authors.affiliation: From the Department of Endoscopy, Shandong Provincial Qianfoshan Hospital, Shandong University (G-DL, X-YJ, H-YD, Q-PP, HLZ, X-JZ, RG, Y-CD), and Department of Gastroenterology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China (C-YQ).
authors.forename: Guo-Dong
authors.initials: GD
authors.lastname: Li
authors.forename: Xin-Yong
authors.initials: XY
authors.lastname: Jia
authors.forename: Hai-Yan
authors.initials: HY
authors.lastname: Dong
authors.forename: Qiu-Ping
authors.initials: QP
authors.lastname: Pang
authors.forename: Hai-Lan
authors.initials: HL
authors.lastname: Zhai
authors.forename: Xiu-Juan
authors.initials: XJ
authors.lastname: Zhang
authors.forename: Rong
authors.initials: R
authors.lastname: Guo
authors.forename: Yan-Chun
authors.initials: YC
authors.lastname: Dong
authors.forename: Cheng-Yong
authors.initials: CY
authors.lastname: Qin
mesh_terms: D000285:Administration, Rectal; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal; D002681:China / Q000453:epidemiology; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007213:Indomethacin / Q000008:administration & dosage*; D008297:Male; D019283:Pancreatitis, Acute Necrotizing / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D057216:Propensity Score; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D007213:Indomethacin