title: Rectal or intramuscular diclofenac reduces the incidence of pancreatitis afterendoscopic retrograde cholangiopancreatography.
abstract: OBJECTIVE
  Acute pancreatitis is the most common adverse event of endoscopic retrograde cholangiopancreatography (ERCP). We aimed to evaluate the efficacy of intramuscular diclofenac sodium for prophylaxis of post-ERCP pancreatitis (PEP) in comparison to the rectal form.
  
  
  METHODS
  One hundred and fifty consecutive patients who underwent ERCP were enrolled in this single-center, prospective, randomized controlled study. Patients were randomized into three groups. The first group received 75 mg of diclofenac sodium via intramuscular route and the second group received 100 mg of diclofenac sodium rectally 30-90 min before the procedure. The third group served as the control group. Patients were evaluated for post-ERCP pancreatitis with serum amylase levels and abdominal pain 24 h after the procedure.
  
  
  RESULTS
  The overall incidence of PEP was 6% (n = 9) and 2% (n = 1) in the intramuscular (IM) and rectal groups, respectively, and 14% in the control group (P = 0.014). Nineteen (12.7%) patients developed post-ERCP abdominal pain (8% in IM, 10% in rectal, and 20% in control group; P = 0.154). Twenty-five (16.6%) patients developed post-ERCP hyperamylasemia (10% in IM, 12% in rectal, and 24% in control group; P = 0.03).
  
  
  CONCLUSIONS
  Prophylaxis with diclofenac given rectally or intramuscularly is an effective option for the management of post-ERCP pancreatitis.
authors: Department of Internal Medicine, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey.
authors: Ramazan
authors: R
authors: Uçar
authors: Department of Gastroenterology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey.
authors: Murat
authors: M
authors: Biyik
authors: Department of Internal Medicine, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey.
authors: Esma
authors: E
authors: Uçar
authors: Division of Internal Medicine, Afyon State Hospital, Afyonkarahisar, Turkey.
authors: İlker
authors: İ
authors: Polat
authors: Department of Gastroenterology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey.
authors: Sami
authors: S
authors: Çifçi
authors: Department of Gastroenterology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey.
authors: Hüseyin
authors: H
authors: Ataseven
authors: Department of Gastroenterology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey.
authors: Ali
authors: A
authors: Demir
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal; D002760:Cholangiopancreatography, Endoscopic Retrograde; D004008:Diclofenac; D006801:Humans; D015994:Incidence; D010195:Pancreatitis; D011446:Prospective Studies
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D004008:Diclofenac
keywords: Diclofenac; ERCP; post-ERCP pancreatitis