title: Comparison of rectal indomethacin, diclofenac, and naproxen for the prevention of post endoscopic retrograde cholangiopancreatography pancreatitis.
abstract: OBJECTIVE
  NSAIDs are commonly utilized for the prevention of post endoscopic retrograde cholangiopancreatography pancreatitis (PEP). However, not much is known about the most effective drug in preventing this complication. This study aims to clarify which drug (indomethacin, diclofenac, or naproxen) is most effective for the prevention of post endoscopic retrograde cholangiopancreatography (ERCP).
  
  
  METHODS
  In a double-blind, randomized study, patients received a single rectal dose of one of the three drugs 30 min before undergoing ERCP: diclofenac (100 mg), indomethacin (100 mg), or naproxen (500 mg). The primary outcome measured was the development of pancreatitis. The levels of serum amylase, lipase, lipoxin A4, and resolvin E1 were measured before ERCP, and at 24 h after the procedure.
  
  
  RESULTS
  Three hundred and seventy-two patients completed the study. The overall incidence of PEP was 8.6%, which occurred in five of the 124 (4%) patients who received diclofenac, seven of the 122 (5.8%) patients who received indomethacin, and 20 of the 126 (15.9%) patients who received naproxen. There were no significant differences in amylase and lipase levels among the three groups (P=0.183 and 0.597, respectively). Unlike patients in the naproxen group, patients in the diclofenac and indomethacin groups showed a significant increase in lipoxin A4 and resolvin E1 (P=0.001 and 0.02, respectively).
  
  
  CONCLUSIONS
  Diclofenac and indomethacin patient groups had a lower incidence of PEP than the naproxen group.
authors.affiliation: aGastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases bDepartment of Clinical Pharmacy, School of Pharmacy cDepartment of Anesthesiology, Akhtar Hospital, Shahid Beheshti University of Medical Sciences dDepartment of Clinical Pharmacy, Islamic Azad University of Pharmaceutical Sciences Branch, Tehran, Iran.
authors.forename: Amir H
authors.initials: AH
authors.lastname: Mohammad Alizadeh
authors.forename: Mohammad
authors.initials: M
authors.lastname: Abbasinazari
authors.forename: Behzad
authors.initials: B
authors.lastname: Hatami
authors.forename: Saeed
authors.initials: S
authors.lastname: Abdi
authors.forename: Forozan
authors.initials: F
authors.lastname: Ahmadpour
authors.forename: Shideh
authors.initials: S
authors.lastname: Dabir
authors.forename: Aida
authors.initials: A
authors.lastname: Nematollahi
authors.forename: Samira
authors.initials: S
authors.lastname: Fatehi
authors.forename: Mohammad A
authors.initials: MA
authors.lastname: Pourhoseingholi
mesh_terms: D000285:Administration, Rectal; D000328:Adult; D000368:Aged; D000681:Amylases / Q000097:blood; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage* / Q000009:adverse effects; D015415:Biomarkers / Q000097:blood; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D004008:Diclofenac / Q000008:administration & dosage* / Q000009:adverse effects; D004311:Double-Blind Method; D015118:Eicosapentaenoic Acid / Q000031:analogs & derivatives / Q000097:blood; D005260:Female; D006801:Humans; D015994:Incidence; D007213:Indomethacin / Q000008:administration & dosage* / Q000009:adverse effects; D007492:Iran / Q000453:epidemiology; D008049:Lipase / Q000097:blood; D044045:Lipoxins / Q000097:blood; D008297:Male; D008875:Middle Aged; D009288:Naproxen / Q000008:administration & dosage* / Q000009:adverse effects; D010195:Pancreatitis / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D015415:Biomarkers; D044045:Lipoxins; C040527:lipoxin A4; D004008:Diclofenac; D009288:Naproxen; D015118:Eicosapentaenoic Acid; D008049:Lipase; C518354:PNLIP protein, human; D000681:Amylases; C499823:5S,12R,18R-trihydroxy-6Z,8E,10E,14Z,16E-eicosapentaenoic acid; D007213:Indomethacin