Abstract
AIM: To compare the effects of new-type versus traditional non-steroid antiinflammtory drugs (NSAIDs) in the prevention of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP).
METHODS: One hundred and ninety-seven patients who underwent ERCP for choledocholithiasis between May 2012 and May 2013 were randomly divided into three groups: a lornoxicam group, a parecoxib group and a control group. Different drugs were applied for each group. Mean visual analogue score (VAS) and serum levels of amylase and C-reactive protein (CRP) were measured before ERCP and 4, 24 and 48 h after ERCP. Incidences of hyperamylasemia and PEP were observed.
RESULTS: The incidences of PEP in the lornoxicam group, parecoxib group and control group were 4.55%, 9.09% and 10.8%, respectively, and the difference was statistically significant between the parecoxib group and control group (P < 0.05), but not between the lornoxicam group and control group (P > 0.05). The incidences of post-ERCP hyperamylasemia in the parecoxib group and lornoxicam group were significantly lower than that in the control group (9.09%, 15.2% vs 21.5%, both P < 0.01). Serum CRP level at 4 h after ERCP was significantly lower in both treatment groups than in the control group (both P < 0.01). Mean VAS at 4 h after ERCP was significantly lower in both treatment groups than in the control group (both P < 0.01).
CONCLUSION: NSAIDs like lornoxicam and parecoxib can prevent the occurrence of hyperamylasemia induced by ERCP. Parecoxib could prevent the occurrence of PEP. Both drugs can alleviate pain and inflammatory reactions after the endoscopic procedure. As a new type of NSAIDs, selective cyclooxygenase-2 (COX-2) inhibitors might be more useful in preventing PEP.
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