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diclofenac and pancreatitis

Yuji Fujita, Sho Hasegawa, Yuri Kato, Ken Ishii, Akito Iwasaki, Takamitsu Sato, Yusuke Sekino, Kunihiro Hosono, Atsushi Nakajima, Kensuke Kubota
Background and study aims: Several meta-analyses and randomized control trials have demonstrated the efficacy of rectal nonsteroidal anti-inflammatory drugs for preventing post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). Diclofenac or indomethacin was administered at a dose of 100 mg in those studies, which may be too high for Asian population. In addition, rectal administration can be considered complicated. Patients and methods: This study was a prospective, randomized, placebo-controlled trial...
October 2016: Endoscopy International Open
Pompilia Ispas-Szabo, Patrick De Koninck, Carmen Calinescu, Mircea Alexandru Mateescu
Carboxymethyl starch (CMS) is a pH-responsive excipient exhibiting also interesting properties for applications in delayed drug delivery systems. This work was aimed to investigate the release properties of monolithic and dry-coated tablets based on ionic sodium CMS and on protonated CMS, formulated with three model tracers: acetaminophen, acetylsalicylic acid (ASA), and sodium diclofenac. The sodium or protonated CMS were obtained from the same CMS synthesis by controlling the final pH of reaction media. The two forms of CMS were confirmed by the Fourier transform infrared spectroscopy...
September 29, 2016: AAPS PharmSciTech
Fernanda de Quadros Onófrio, Julio Carlos Pereira Lima, Guilherme Watte, Romnei Lenon Lehmen, Daniela Oba, Gabriela Camargo, Carlos Eduardo Oliveira Dos Santos
Background Acute pancreatitis is the most common complication after ERCP, occurring in about 4 % of the procedures. Only the placement of pancreatic duct prosthesis and the use of nonsteroidal anti-inflammatory drugs (NSAIDs) have shown benefit in the prevention of post-ERCP pancreatitis (PEP). Although the benefit of rectal administration of indomethacin or diclofenac is recommended by some studies and society guidelines especially in a selected group of high-risk patients, there is so far, no standardization of time or route of NSAID administration...
September 20, 2016: Surgical Endoscopy
Salvatore F Vadalà di Prampero, Giacomo Faleschini, Nikola Panic, Milutin Bulajic
BACKGROUND AND AIM: Postendoscopic retrograde cholangiopancreatography (post-ERCP) pancreatitis (PEP) is the most common complication following ERCP. We carried out a systematic review and meta-analysis of the global literature on PEP prevention to provide clinical guidance and a framework for future research in this important field. METHODS: PubMed, Embase, Science Citation Index, Ovid, and the Cochrane Controlled Trials Register were searched by two independent reviewers to identify full-length, prospective, randomized controlled trials (RCTs) published up until March 2016 investigating the use of pancreatic duct stents and pharmacological agents to prevent PEP...
August 31, 2016: European Journal of Gastroenterology & Hepatology
Tiing Leong Ang, Andrew Boon Eu Kwek, Mingjun Song, James Weiquan Li, Prem Harichander Thurairajah
OBJECTIVES: Needle knife precut sphincterotomy (PS) during endoscopic retrograde cholangiopancreatography (ERCP) has been associated with a higher risk of post-ERCP pancreatitis (PEP). This study examined the effect of no prophylaxis, somatostatin, rectal diclofenac and pancreatic duct (PD) stenting in reducing the rates of PEP in patients who underwent early PS. METHODS: The study period was January 2006 to December 2015. A standardized approach to early PS was used: 1) inadvertent guidewire cannulation of PD > 3 times; 2) impacted bile duct stone; 3) inability to achieve deep cannulation within 10 minutes...
August 24, 2016: Journal of Digestive Diseases
Ramazan Uçar, Murat Biyik, Esma Uçar, İlker Polat, Sami Çifçi, Hüseyin Ataseven, Ali Demir
BACKGROUND/AIM: Acute pancreatitis is the most common adverse event of endoscopic retrograde cholangiopancreatography (ERCP). We aimed to evaluate the efficacy of intramuscular diclofenac sodium for prophylaxis of post-ERCP pancreatitis (PEP) in comparison to the rectal form. MATERIALS AND METHODS: One hundred and fifty consecutive patients who underwent ERCP were enrolled in this single-center, prospective, randomized controlled study. Patients were randomized into three groups...
2016: Turkish Journal of Medical Sciences
Hirotoshi Ishiwatari, Takahiro Urata, Ichiro Yasuda, Shimpei Matsusaki, Hiroyuki Hisai, Hiroshi Kawakami, Michihiro Ono, Takuji Iwashita, Shinpei Doi, Kazumichi Kawakubo, Tsuyoshi Hayashi, Tomoko Sonoda, Naoya Sakamoto, Junji Kato
BACKGROUND: Pancreatitis following endoscopic retrograde cholangiopancreatography (ERCP) is a serious complication. Rectal diclofenac (100 mg) has been shown to reduce the incidence of pancreatitis; however, this dosage form is unavailable in several countries. AIMS: We aimed to investigate the preventive effect of oral diclofenac on pancreatitis after ERCP in a multicenter, randomized, prospective, placebo-controlled, double-blind trial. METHODS: Patients undergoing a first ERCP in seven high-volume centers between July 2012 and August 2014 were considered eligible...
November 2016: Digestive Diseases and Sciences
Goran Hauser, Ivana Blažević, Nermin Salkić, Goran Poropat, Vanja Giljača, Zlatko Bulić, Davor Štimac
BACKGROUND AND AIMS: We aimed to compare the efficacy of prophylactic, parenterally administered ceftazidime and rectally applied diclofenac sodium for the prophylaxis of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). METHODS: We prospectively enrolled patients who underwent ERCP. In a double-blind, randomized, controlled trial, patients received a suppository containing diclofenac sodium rectally (100 mg) and placebo intravenously (group A) or ceftazidime intravenously (1 g) and placebo rectally (group B) immediately before the procedure...
June 17, 2016: Surgical Endoscopy
Bonna Leerhøy, Andreas Nordholm-Carstensen, Srdan Novovic, Mark Berner Hansen, Lars Nannestad Jørgensen
OBJECTIVE: The aim of this study was to assess the influence of patient body weight on the clinical effect of 100 mg diclofenac administered as a single dose for the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP). MATERIALS AND METHODS: All patients subjected to endoscopic retrograde cholangiopancreatography (ERCP) from 2009 to 2014 were evaluated for inclusion. In total, 772 patients were included of whom 378 (49%) received diclofenac prophylaxis...
August 2016: Scandinavian Journal of Gastroenterology
Alberto Mariani, Milena Di Leo, Nicola Giardullo, Antonella Giussani, Mario Marini, Federico Buffoli, Livio Cipolletta, Franco Radaelli, Paolo Ravelli, Giovanni Lombardi, Vittorio D'Onofrio, Raffaele Macchiarelli, Elena Iiritano, Marco Le Grazie, Giuseppe Pantaleo, Pier Alberto Testoni
BACKGROUND AND STUDY AIM: Precut sphincterotomy is a technique usually employed for difficult biliary cannulation during endoscopic retrograde cholangiopancreatography (ERCP) for the treatment of bile duct disease. It is a validated risk factor for post-ERCP pancreatitis (PEP), but it is not clear whether the risk is related to the technique itself or to the repeated biliary cannulation attempts preceding it. The primary aim of the study was to assess the incidence of PEP in early precut compared with the standard technique in patients with difficult biliary cannulation...
June 2016: Endoscopy
Ewa Łubowska-Pająk, Krzysztof Kołomecki
UNLABELLED: Endoscopic retrograde cholangiopancreatography (ERCP) is an effective tool in the diagnostics and treatment of bile duct diseases. Although minimally invasive, the procedure is associated with a risk of complications, with acute pancreatitis being the most serious. In recent years, high hopes have been placed on pharmacological prevention of acute pancreatitis after ERCP. The aim of the study was assessment of the efficacy of low-molecular-weight heparin and somatostatin in combination with diclofenac in the prevention of acute pancreatitis after ERCP...
December 2015: Polski Przeglad Chirurgiczny
Ozlem Ozer Cakir, Hasan Esen, Aysun Toker, Huseyin Ataseven, Ali Demir, Hakki Polat
BACKGROUND: Research continues to develop novel therapeutic modalities that particularly focus on the pathogenesis of acute pancreatitis. This study aimed to assess the effects of diclofenac sodium and octreotide, alone or in combination, on pancreatic enzymes, pancreatic myeloperoxidase activity, histopathology and apoptosis of pancreas cells, using a model of experimentally induced acute pancreatitis. OBJECTIVES: We aimed to demonstrate effects of diclofenac sodium, octreotide and their combined use on pancreatic enzymes, activity of pancreatic myeloperoxidase (MPO) activity, histopathology and apoptosis of pancreas on treatment of caerulin-induced experimental acute pancreatitis...
2015: International Journal of Clinical and Experimental Medicine
Muhammad S Sajid, Amir H Khawaja, Mazin Sayegh, Krishna K Singh, Zinu Philipose
AIM: To critically appraise the published randomized, controlled trials on the prophylactic effectiveness of the non-steroidal anti-inflammatory drugs (NSAIDs), in reducing the risk of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. METHODS: A systematic literature search (MEDLINE, Embase and the Cochrane Library, from inception of the databases until May 2015) was conducted to identify randomized, clinical trials investigating the role of NSAIDs in reducing the risk of post-ERCP pancreatitis...
December 25, 2015: World Journal of Gastrointestinal Endoscopy
Jessica S Fortin, Marie-Odile Benoit-Biancamano
Nonsteroidal anti-inflammatory drugs (NSAIDs) constitute an important pharmacotherapeutic class that, over the past decade, have expanded in application to a panoply of medical conditions. They have been tested for neurodegenerative diseases such as Alzheimer's to reduce inflammation and also in the attempt to abrogate amyloid deposition. However, the use of NSAIDs as aggregation inhibitors has not been extensively studied in pancreatic amyloid deposition. Pancreatic amyloidosis involves the misfolding of islet amyloid polypeptide (IAPP) and contributes to the progression of type-2 diabetes in humans and felines...
January 2016: Canadian Journal of Physiology and Pharmacology
Crystal L Whitted, Victoria E Palau, Ruben D Torrenegra, Sam Harirforoosh
Isomers 5,7-dihydroxy-3,6,8-trimethoxy-2-phenyl-4H-chromen-4-one (5,7-dihydroxy-3,6,8 trimethoxy flavone) (flavone A) and 3,5-dihydroxy-6,7,8-trimethoxy-2-phenyl-4H-chromen-4-one (3,5-dihydroxy-6,7,8-trimethoxy flavone) (flavone B) have recently demonstrated differential antineoplastic activities against pancreatic cancer in vitro. These studies also indicated that these compounds target highly tumorigenic cells while sparing normal cells. The in vivo antitumor activities of these flavones have not been determined, and detection protocols for these compounds are needed to conduct pre-clinical assays following intravenous dosing...
September 15, 2015: Journal of Chromatography. B, Analytical Technologies in the Biomedical and Life Sciences
Tarun Rustagi, Basile Njei
OBJECTIVES: To identify the factors affecting the efficacy of nonsteroidal anti-inflammatory drugs (NSAIDs) in preventing post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). METHODS: We systematically searched databases for relevant studies published from inception to November 2013. RESULTS: A meta-analysis of 11 randomized trials (n = 2497) revealed a significant reduction in PEP in patients who received NSAIDs compared with that in patients who received placebo (relative risk [RR], 0...
August 2015: Pancreas
Tilak Shah, Alvin Zfass, Mitchell L Schubert
No abstract text is available yet for this article.
October 2015: Digestive Diseases and Sciences
Árpád Patai, Árpád V Patai, Norbert Solymosi, Zsolt Tulassay, László Herszényi
Over 14,000 endoscopic retrograde cholangiopancreatographies are performed in Hungary annually, and approximately 1400 patients are calculated to develop pancreatititis including 10 cases with fatal outcome. This article reviews the recent and relevant literature and presents a practical guide based on the authors' own experience for the prevention of pancreatitis following endoscopic retrograde cholangiopancreatography. The authors emphasize the importance of careful consideration of indications, analysis of risk factors, avoiding unnecessary diagnostic intervention, a decrease of the attempts for cannulation, early precut, implantation of pancreatic stent in high risk patients, administration of rectal indomethacin or diclofenac, and adequate intravenous fluid replacement...
May 3, 2015: Orvosi Hetilap
Takeo Yoshihara, Masayoshi Horimoto, Tetsuhisa Kitamura, Naoto Osugi, Tatsuro Ikezoe, Kaori Kotani, Toru Sanada, Churi Higashi, Daisuke Yamaguchi, Makiyo Ota, Tatsunori Mizuno, Yasukazu Gotoh, Yorihide Okuda, Kunio Suzuki
OBJECTIVES: The aim of the present study was to assess the appropriate administration dose of non-steroidal anti-inflammation drugs to prevent pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP). Importantly, the 100 mg dose of diclofenac recommended in Western countries has not been permitted in Japan. DESIGN: A retrospective study. SETTINGS: A single centre in Japan. PARTICIPANTS: This study enrolled patients who underwent ERCP at the Department of Gastroenterology, Osaka Saiseikai Senri Hospital, from April 2011 through June 2013, and who received either a 25 or a 50 mg dose of rectal diclofenac after ERCP...
2015: BMJ Open
Guan Way Lua, Raman Muthukaruppan, Jayaram Menon
BACKGROUND: Non steroidal anti-inflammatory drugs (NSAIDs) have been shown to reduce the incidence of post endoscopic retrograde cholangiopancreatography pancreatitis (PEP). There were various trials using different routes and dosages of NSAIDs but meta-analysis revealed inconsistent results. AIMS: The aims of this study were to determine the efficacy of rectal diclofenac in preventing PEP and to evaluate any adverse events. METHODS: This was a randomized, open-label, two-arm, prospective clinical trial...
October 2015: Digestive Diseases and Sciences
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