Comparison of the incidence of post-ERCP pancreatitis between combined rectal indomethacin and sublingual nitroglycerin with that of rectal indomethacin alone

M. Khademul Islam; M. Anwarul Kabir; Chanchal Kumar Ghosh; Khaleda Begum; Mohammad Reazuddin Danish; M. Sarower Islam; Chinmoy Saha; Muhammad Asif Ikbal

doi:10.18203/2320-6012.ijrms20241876

Authors

M. Khademul Islam Department of Medicine, Upazila Health Complex, Fulbaria, Mymensingh, Bangladesh
M. Anwarul Kabir Department of Gastroenterology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
Chanchal Kumar Ghosh Department of Gastroenterology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
Khaleda Begum Department of Pediatrics, Mymensingh Medical College Hospital, Mymensingh, Bangladesh
Mohammad Reazuddin Danish Department of Gastroenterology, Ibn Sina Medical College and Hospital, Dhaka, Bangladesh
M. Sarower Islam Department of Gastroenterology, Sheikh Russell National Gastroliver Institute Hospital, Dhaka, Bangladesh
Chinmoy Saha Department of Gastroenterology, Sheikh Russell National Gastroliver Institute Hospital, Dhaka, Bangladesh
Muhammad Asif Ikbal Department of ENT, Fulbaira Upazila Health Complex, Mymensingh, Bangladesh

DOI:

https://doi.org/10.18203/2320-6012.ijrms20241876

Keywords:

Comparison, Rectal indomethacin, Sublingual nitroglycerin, ERCP, PEP

Abstract

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is now widely accepted as a therapeutic modality for benign and malignant diseases of the pancreaticobiliary tree. Acute pancreatitis is the most common and feared complication of ERCP, associated with substantial morbidity and mortality. This study aimed to compare the incidence of post-ERCP pancreatitis in combined rectal indomethacin and sublingual nitroglycerin with that of rectal indomethacin alone.

Methods: This was a randomized controlled trial conducted in the Department of Gastroenterology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh during the period from July, 2019 to September, 2020. In this study, 100 hospitalized patients of >18 years age undergoing ERCP based on clinical indication and proper investigation were included. The study population was randomly divided into two groups - group A (patients who were given indomethacin suppository plus sublingual glyceryl trinitrate) and group B (patients who were given indomethacin alone).

Results: In this study, we found that PEP developed in 11 out of 100 patients (11%). Post-ERCP pancreatitis developed in 2 (4%) in group A and 9 (18%) in group B (p=0.025), which was statistically significant. Mild PEP developed in none in group A and 4 (8%) in group B whereas moderate in 2 (4%) in group A and 3 (6%) in group B. Severe pancreatitis occurred in none in group A and 2 (4%) in group B (p=0.231) which was not statistically significant.

Conclusions: This study showed that the combination of indomethacin suppository and sublingual GTN is superior to indomethacin suppository alone in preventing post-ERCP pancreatitis.

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