Randomized Controlled Study Of Prevention Of Post ERCP Pancreatitis By Prophylactic Pancreatic Duct Stent And NSAIDs

Objective To evaluate the effect of prophylactic pancreatic duct stent(PPDS) Non-Steroid Anti-Inflammtory Drugs(NSAIDs), joint PPDS and NSAIDs preventing Post Endoscopic rectrograde cholangiopancreato-graphy(ERCP) Pancreatitis(PEP) in choledocholithiasis patients.Contents This study intended to solve:whether prophylactic pancreatic duct stenting drainage could reduce the incidence and severity of PEP; parecoxib as a representative of the new cox-2inhibitor NSAIDs could reduce the incidence and severity of PEP or not; The prophylactic use of NSAIDs drugs compared with prophylactic pancreatic duct stenting drainage,which method is more effective; And whether joint use of prophylactic drugs NSAIDs and the prophylactic pancreatic duct stenting drainage can more effectively reduce the incidence and severity of PEP.Methods Using randomised controlled study, first period:200choledocholithiasis patients underwent randomised controlled study on original and new type NSAIDs preventing PEP.Second period:200choledocholithiasis patients underwent study on PPDS and the new cox-2inhibitor NSAIDs single or joint use preventing PEP.Results First period:The incidence of PEP in Lornoxicam group, Parecoxib group and control group are4.55%,9.09%,10.8%. The difference is statistically significant between Parecoxib group and control group (P<0.05). PEP of Lornoxicam group is lower than control group. But it is not statistically significant (P>0.05). The incidence of post-ERCP hyperamylasemia in the Parecoxib group (9.09%) is much lower than that in control group (21.5%)(P<0.01). While Lornoxicam group (15.2%) is lower than control group with statistically significant difference. Serum CRP level4h after ERCP of both group is lower than that of control group. This difference is statistically significant (P<0.01). Mean Visual Analogue Score(VAS) pain scores at4h after ERCP of both group is lower than that of control group. This difference is statistically significant (P<0.01). Second period:200choledocholithiasis patients were randomly divided into4groups, prophylactic pancreatic duct stent(PPDS) to prevent PEP(group A), NSAIDs to prevent PEP(group B), joint PPDS-NSAIDs to prevent PEP (group C) and No prevention for PEP(group D). (1) Incidence of hyperamylasemia48h after ERCP:group A, group B and group C were6%(3/50),6%(3/50) and4%(2/50), which were significantly lower than that of group D(11/55)(P<0.05).(2) Incidence of PEP48h after ERCP:group A and group C were2%(1/50),10%(5/50), which was lower than that in group D (P<0.05); Group B (4%,2/50) was lower than that of group D but there was no statistical significance(P>0.05).(3) VAS score:All scores4h,24h and48h postoperation were significantly higher than preoperation scores of corresponding group (P<0.05); Group B scored significantly lower group D4h,24h and48h postoperation (P<0.05); Group A and group C scored lower than group D only4h after treatment (P<0.05),24h and48h postoperation the score is lower than that of group D but there was no statistical significance (P>0.05).(4) Serum CRP level:All values4h,24h and48h postoperation were significantly higher than preoperation values of corresponding group. Group B and group C were significantly lower than group D4h,24h and48h postoperation. Group A was significantly lower than group D4h,24h postoperation,48h postoperation group A is lower than group D but there was no statistical significance (P>0.05)Conclusion First period:NSAIDs like Lornoxicam and Parecoxib prevent hyperamylasemia induced by ERCP. Parecoxib could prevent PEP. Both methods can alleviate the pain and inflammatory inflammatory reactions after endoscopic procedure. As a new type of NSAIDs, selected Cyclo-oxygen-ase-2(COX-2) inhibitors might be useful in preventing PEP.Second period:(1) Both prophylactic pancreatic duct stent and NSAIDs (Parecoxib Sodium) can reduce incidence of hyperamylasemia after ERCP common bile duct lithotomy, single or joint use of prophylactic pancreatic duct stent can prevent PEP. Prophylactic pancreatic duct stent and NSAIDs (Parecoxib Sodium) can reduce pain and inflammation after ERCP common bile duct lithotomy, which single use of NSAIDs (Parecoxib Sodium) was better than single use of prophylactic pancreatic duct stent and joint use of both method.