Clinical Endoscopy

Original Articles

Role of vitamin C and rectal indomethacin in preventing and alleviating post-endoscopic retrograde cholangiopancreatography pancreatitis: a clinical study: Amir Sadeghi, Rana Jafari-Moghaddam, Sara Ataei, Mahboobe Asadiafrooz, Mohammad Abbasinazari; Clin Endosc 2023;56(2):214-220. Published online March 6, 2023; DOI: https://doi.org/10.5946/ce.2022.165

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Background
/Aims: This study aimed to determine whether vitamin C in addition to indomethacin decreases the occurrence and severity of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) occurrence and severity.
Methods
This randomized clinical trial included patients undergoing ERCP. The participants were administered either rectal indomethacin (100 mg) plus an injection of vitamin C (500 mg) or rectal indomethacin (100 mg) alone just before ERCP. The primary outcomes were PEP occurrence and severity. The secondary amylase and lipase levels were determined after 24 hours.
Results
A total of 344 patients completed the study. Based on intention-to-treat analysis, the PEP rates were 9.9% for indomethacin plus vitamin C plus indomethacin and 15.7% for indomethacin alone. Regarding the per-protocol analysis, the PEP rates were 9.7% and 15.7% in the combination and indomethacin arms, respectively. There was a remarkable difference between the two arms in PEP occurrence and severity on intention-to-treat and per-protocol analyses (p=0.034 and p=0.031, respectively). The post-ERCP lipase and amylase concentrations were lower in the combination arm than in the indomethacin alone arm (p=0.034 and p=0.029, respectively).
Conclusions
Vitamin C injection in addition to rectal indomethacin reduced PEP occurrence and severity.

Citations

Citations to this article as recorded by

Effect of CoQ10 Addition to Rectal Indomethacin on Clinical Pancreatitis and Related Biomarkers in Post-endoscopic Retrograde Cholangiopancreatography
Saeed Abdi, Roja Qobadighadikolaei, Faezeh Jamali, Maryam Shahrokhi, Farzaneh Dastan, Mohammad Abbasinazari
Journal of Cellular & Molecular Anesthesia.2024;[Epub] CrossRef
Double-guidewire technique for selective biliary cannulation does not increase the rate of post-endoscopic retrograde cholangiopancreatography pancreatitis in patients with naïve papilla
Han Taek Jeong, June Hwa Bae, Ho Gak Kim, Jimin Han
Clinical Endoscopy.2024; 57(2): 226. CrossRef

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The Utility of Endoscopic Ultrasound in Patients with Isolated Elevations in Serum Amylase and/or Lipase: Lalitha M. Sitaraman, Amit H. Sachdev, Tamas A. Gonda, Amrita Sethi, John M. Poneros, Frank G. Gress; Clin Endosc 2019;52(2):175-181. Published online January 16, 2019; DOI: https://doi.org/10.5946/ce.2018.110

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Background
/Aims: The aim of this study was to describe the diagnostic yield of endoscopic ultrasound (EUS) in patients with isolated elevated levels of amylase and/or lipase.
Methods
A retrospective chart review was conducted at a large academic medical center from 2000 to 2016. Patients were selected based on having elevated amylase, lipase, or both, but without a diagnosis of pancreatitis or known pancreatobiliary disease. Patients were excluded if they had abnormal liver function tests or abnormal imaging of the pancreas.
Results
Of 299 EUS procedures performed, 38 met inclusion criteria. Symptoms were present in 31 patients, most frequently abdominal pain (87%). In 20 patients (53%), initial EUS most commonly found chronic pancreatitis (n=7; 18%), sludge (5; 13%), or new diagnosis of pancreas divisum (3; 8%). In the asymptomatic patients (7), 3 had a finding on EUS, most importantly sludge (2), stone (1), and pancreas divisum (1). No patients were diagnosed with a mass or pancreatic cyst. During the follow up period, 6 patients (22%) had cholecystectomy.
Conclusions
In our study of patients with isolated elevations in amylase and/or lipase without acute pancreatitis who underwent EUS, approximately 50% had a pancreatobiliary finding, most commonly chronic pancreatitis or biliary sludge.

Citations

Citations to this article as recorded by

Endosonographic features in patients with non-alcoholic early chronic pancreatitis improved with treatment at one year follow up
Kazutoshi Higuchi, Seiji Futagami, Hiroshi Yamawaki, Makoto Murakami, Kumiko Kirita, Shuhei Agawa, Go Ikeda, Hiroto Noda, Yasuhiro Kodaka, Nobue Ueki, Keiko Kaneko, Katya Gudis, Ryuji Ohashi, Katsuhiko Iwakiri
Journal of Clinical Biochemistry and Nutrition.2021; 68(1): 86. CrossRef
Do Patients with Pancreatic Hyperenzymemia without Abnormal Imaging Need Additional Endoscopic Ultrasound?
Jung Wan Choe, Jong Jin Hyun
Clinical Endoscopy.2019; 52(2): 97. CrossRef

9,538 View
162 Download
3 Web of Science
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