所有受到质疑的ERCP患者的常规预防性吲哚美辛
来自随机，安慰剂对照的双盲临床试验的发现引起了人们对所有接受内窥镜逆行胆管造影术（ERCP）的患者预防性胰腺炎对胰腺炎预防的有用性的怀疑。1连续ERCP患者随机接受单剂吲哚美辛（100 mg，直肠）在ERCP之前未能表现出任何统计学意义上的显着降低，而后ERCP胰腺炎（PEP）（PEP）（7.9％）（与随机化为安慰剂相比（7.9％）（7.9％）（7.9％）4.4％）。吲哚美辛和安慰剂组也可能在ERCP后30天内体验住院入院（图）。
约翰·M·莱文克（John M. Levenick），医学博士，医学，胃肠病学和肝病学助理教授，以及在达特茅斯 - 希区柯克医学中心进行的试验的首席研究员，并补充说：“即使在接受高风险的患者中，我们也未能找到吲哚美辛的任何好处。此外，吲哚美辛在发生时没有调节PEP的严重程度。在吲哚美辛治疗的患者中与安慰剂治疗的患者一样严重。”由于统计学上的徒劳行为，该试验早期停止了，该试验显示了原发点（PEP出现）的吲哚美辛和安慰剂之间的任何显着差异。
The study findings, presented as a poster at the 2015 American College of Gastroenterology annual meeting, received the Presidential Poster Award and are likely to spur a reevaluation of chemoprophylaxis of PEP using indomethacin. Dr. Levenick explains, “This study was prompted by a recent shift toward universal use of indomethacin for prevention of post-ERCP pancreatitis, largely based on a study in very high-risk ERCP patients, which showed a significant indomethacin preventive benefit.2我们想检查在更典型的ERCP患者人群中的收益是否明显。”
Based on this study and others, the European Society for Gastrointestinal Endoscopy (ESGE) guidelines3recommended routinely giving prophylactic rectal indomethacin to all patients undergoing ERCP, including those at average risk for PEP, despite its efficacy in this population being unproven. Among ERCP patients enrolled in the earlier 2012 trial from Elmunzer, et al.2在Levenick等人报道的试验中，有82.3％的人怀疑ODDI的括约肌怀疑Oddi的括约肌，而只有2.8％的ODDI怀疑ODDI。1Levenick博士指出,“从Elmunzer审判in a group of patients at very high PEP risk. It does not seem prudent to generalize the findings to the typical ERCP patient commonly seen in the clinic without careful study.” Pancreatitis is the most common serious complication associated with ERCP; suspicion of sphincter of Oddi is recognized as a major risk factor for PEP. No guidelines pertaining to this issue have been issued from the American Society for Gastrointestinal Endoscopy.
This study is supported in part by grants from the National Pancreas Foundation.
约翰·M·莱文克（John M. Levenick），医学博士
Assistant Professor of Medicine
Phone:717-531-6261
电子邮件：jlevenick@pennstatehealth.psu.edu
Fellowship:高级内窥镜检查，达特茅斯希区柯克医疗中心，新罕布什尔州黎巴嫩；N.H.黎巴嫩达特茅斯希区柯克医学中心的胃肠病学
居住：Internal medicine, Dartmouth Hitchcock Medical Center, Lebanon, N.H.
医学院：斯特里奇医学院，芝加哥洛约拉大学，伊利诺伊州梅伍德。
在Doximity上与医学博士John M. Levenick联系
REFERENCES:
- Levenick JM，Gordon SR，Fadden LL等。2016。直肠吲哚美辛不能预防连续患者的ERCP后胰腺炎，这是一项随机试验。Gastroenterology。Jan 8. [Epub ahead of print]
- Elmunzer BJ，Scheiman JM，Lehman GA等。用于内窥镜检查结果研究的美国合作社（USCORE）。2012。直肠吲哚美辛的随机试验，以防止ERCP后胰腺炎。N Engl J Med.366(15):1414-22.
- Dumonceau JM，Andriulli A，Elmunzer BJ等。2014。Prophylaxis of post- ERCP pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Guideline- 2014年6月更新。Endoscopy。46:799-815.