The Application Value Of Low-dose Diclofenac In The Prevention Of Post-ERCP Pancreatitis

Objective: To investigate the preventive effects of diclofenac 50 mg and 100 mg via rectum on hyperamylasemia,C-reactive protein and pancreatitis after ERCP(endoscopic retrograde cholangiopancreatography).To evaluate the application value of low-dose diclofenac in the prevention of post-ERCP pancreatitis.Methods: 150 patients who were diagnosed with common bile duct stones and other obstructive jaundice from 2014-06 to 2015-12 in Yancheng Affiliated Hospital of Southeast University by B ultrasound,CT,and MRCP were randomly divided into A,B,C three groups and each group was 50 cases.50 mg of diclofenac suppositories was administered via rectum in the group A after operation,100 mg of diclofenac suppositories was administered via rectum in the group B after operation,while no diclofenac suppositories was given in the group C.In addition,diazepam(10mg)and scopolamine(0.3mg)and pethidine(50mg)was given in both groups 10 minutes before ERCP.Serum amylase,C-reactive protein level value and patient pain visual analogue scale were detected before ERCP,6 hours and 24 hours after the operation.The occurrence of post-ERCP pancreatitis(PEP)and hyperamylasemia was also observed.Results:All patients were successfully completed operation.The serum amylaselevels(U/L)of 6 hours after ERCP in group A and group B were(88.61± 20.13),(87.81±19.23),were lower than the control groups(126.87 ± 40.66)(P <0.05).The serum amylase-levels(U/L)of 24 hours after ERCP in group A and group B were(73.68±26.72),(74.97±16.09),were lower than the control groups(105.41±22.48)(P <0.05),the difference between group A and B after 6h and 24 h with serum amylase levels has no statistically significant(P>0.05);The C-reactive protein levels(mg/L)of 6 hours after ERCP in group A and group B were(24.61±15.08),(25.22±14.73),were lower than the control group(46.72±16.18)(P <0.05),The C reactive protein level(mg/L)of 24 hours after ERCP in group A and group B were(19.39±12.53),(20.35±13.07),were lower than the control group(38.54 ± 14.79)(P <0.05),the difference between group A and B after 6h and 24 h with C-reactive protein levels has no statistically significant(P>0.05);The VAS pain scores in group A and group B after 6 hours of ERCP were(3.34±1.56)and(3.91±1.75),were lower than the group C(6.72±2.28)(P<0.05);The VAS pain scores in group A and group B after 24 hours of ERCP were(1.93±1.36)and(1.89±2.04),were lower than the group C(2.57±2.11)(P<0.05),the difference between group A and B after 6h and 24 h with VAS pain scores has no statistically significant(P>0.05);The rates of PEP in group A and B were 6%,6%,were lower than the group C 14%(P<0.05),the incidence of hyperamylasemia in group A and B were 12%,14%,were lower than the group C 26%(P <0.05),group A compared with group B in the rates of PEP and hyperamylasemia have no statistically significant(P> 0.05).Conclusion: Rectal use of low-dose diclofenac suppositories can effectively decrease the occurrence of post-ERCP pancreatitis and hyperamylasemia in patients after ERCP.