The Clinical Study Of Indomethacin Suppository On The Prevention Mechanism Of Hyperamylase And Pancreatitis After ERCP

Objective1.To investigate the preventive effect of Rectal indomethacin for post-ERCP pancreatitis（PEP）and hyperamylasemia after endoscopic retrograde Cholangiopancreatography（ERCP）.Evaluation the value of indomethacin in prevention of post-ERCP pancreatitis and hyperamylasemia.2.To measure the levels of serum PGE₂、IL-17、TNF-αin different times before and after ERCP,analyse the effect of Indomethacin for mediator of inflammation post ERCP;infer the possible molecular mechanisms in prevention of post ERCP pancrestitis and hyperamylasemia.MethodsFrom August 2016 to June 2017,70 patients undergoing ERCP will be randomly assigned to Indomethacin group and control group according to the condition of entering the group and the screening criteria.100mg of Indomethacin suppositories was administered via rectum in the preventive group 30 minutes before ERCP,while placebo suppositories was given in the control group.We observed the plasma amylase levels at pre-ERCP、post-ERCP 3h and post ERCP 24h and the occurrence of stomachache,counted the incidence of PEP in two groups.Meanwhile,the serum PGE₂、IL-17、TNF-αlevels at post-ERCP 3h and post ERCP 24h in patients were detected.Results1.Comparison of postoperative complications Of the 70 patients,9 were complicated with pancreatitis（12.86%）,24 with hyperamylasemia（34.29%）,no bleeding,perforation,and acute cholangitis.The control group 8 cases of acute pancreatitis after operation（22.86%）,10 cases of hyperamylasemia（28.57%）,17 cases without complications;pancreatitis patients in the observation group of 1 cases（2.86%）,significantly lower than the control group（P<0.05）,hyperamylasemia in14 cases（40%）,20 cases without complications.There was no significant difference in the total complication rate between the two groups（P>0.05）2.Indexes results in different time internals There were no significant difference in the preoperative PGE₂,IL-17 and TNF-аlevel between the two groups（P>0.05）.The PGE₂,IL-17,TNF-аlevel in the observation group were lower than that of the control group at postoperative 3 h（P<0.05）.The IL-17 and TNF-аlevel in the observation group were lower than that of the control group at postoperative 24 h（P<0.05 and P<0.01）.There was no significant difference in PGE₂between the 2 groups at postoperative 3 h and 24 h（P>0.05）;The preoperative and postoperative IL-17 and TNF-аlevel was significant difference in the control group（P<0.05）,IL-17 level at postoperative 3h and 24 h was higher than that before operation（P<0.01）,TNF-аlevel at postoperative 3h was higher than that before operation（P<0.05）,while there had no statistical significance in the observation group（P>0.05）.ConclusionIndomethacin suppositories preoperative anus can effectively reduce the incidence of post ERCP pancreatitis,this may be related to the decrease in PGE₂,IL-17,TNF-аlevel.ObjectiveBy monitoring the changes of Th17 and Treg cell ratio in peripheral blood before and after ERCP,the possible cellular mechanism of Indomethacin Suppositories anus to prevent post-ERCP pancreatitis and hyperamylasemia in ERCP patients was analyzed.MethodsFrom April 2017 to September 2017,44 patients undergoing ERCP will be randomly assigned to Indomethacin group and control group according to the condition of entering the group and the screening criteria.100 mg of Indomethacin suppositories was administered via rectum in the preventive group 30 minutes before ERCP,while placebo suppositories was given in the control group.The changes of Th17,Treg cell ratio and Treg/Th17 ratio in peripheral blood of two groups at pre-ERCP、post-ERCP 12 h were monitored.Results1.control group: the proportion of Th17 in peripheral blood after 12 h was higher than the preoperative level（3.07 + 2.055% vs 2.607 + 1.857%）,the difference was statistically significant（P < 0.05）;the proportion of Treg in peripheral blood of postoperative 12 h was lower than the preoperative level（2.083 + 1.238% vs 2.708 + 1.583%）,the difference was statistically significant（P < 0.05）;the ratio of Treg/Th17 in peripheral blood of postoperative 12 h was significantly lower than the preoperative level（0.995 + 0.803 vs 2.189 + 2.51）,the difference was statistically significant（P < 0.01）.2.the observation group: the proportion of Th17 in peripheral blood after 12 h is slightly higher than the preoperative level（2.554 + 1.267% vs 2.379 + 1.536%）,there was no statistically significant difference（P > 0.05）;the proportion of Treg in peripheral blood of postoperative 12 h was slightly lower than the preoperative level（1.737 + 1.237% vs2.011 + 1.374%）,the difference was not statistically significant（P >0.05）;postoperative peripheral blood 12 h Treg/Th17 ratio is slightly lower than the preoperative level（0.983 + 1.062 vs 1.264 + 1.12）,there was no statistically significant difference（P > 0.05）.3.comparison between the two groups: preoperative,postoperative 12 h two groups of peripheral blood Th17,Treg,Treg/Th17 comparison,the difference was not statistically significant（P > 0.05）.Conclusion1.The imbalance of Th17/Treg cells to the proinflammatory side after human ERCP can promote the development of inflammation.2.Preoperative Indomethacin Suppositories anus can effectively improve the immune imbalance of Th17 and Treg after ERCP,which may be related to reducing the incidence of pancreatitis and hyperamylasemia after ERCP.