Prevention of Post-ERCP Pancreatitis by Indomethacin Vs Diclofenac

NCT ID: NCT05947461

Last Updated: 2024-10-28

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

TERMINATED

Clinical Phase

NA

Total Enrollment

1204 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-06-01

Study Completion Date

2024-06-22

Brief Summary

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Post-ERCP pancreatitis (PEP) is the most common complication after ERCP, which was associated with occasional mortality, prolonged hospital days and increased health costs. Some studies investigated the effectiveness of different Nonsteroidal antiinflammatory drugs (NSAIDs) for prevent PEP. However, several high-quality RCTs and meta-analyses consistently demonstrated only100mg rectal indomethacin or diclofenac significantly reduced PEP incidence compared with placebos. Thus, European Society of Gastrointestinal Endoscopy, American Society for Gastrointestinal Endoscopy and Japanese Society of Hepato-Biliary-Pancreatic surgery guidelines recommended rountine administration of 100mg rectal indomethacin or diclofenac in unselected patients who underwent ERCP.

Up to date, the mechanisms of NSAIDs in preventing pancreatitis were not fully elucidated. Diclofenac and Indomethacin showed similar inhibitory effects in phospholipase A2 and cyclooxygenase pathways. And the peak concentration of diclofenac and indomethacin both occurs between 30 and 90 min after rectal administration. However, diclofenac may be a stronger inhibitor of other pancreatitis-related imflammatory siginals (e.g. nuclear factor kappa-B) than indomethacin. Recently, several meta-analyses found 100mg rectal diclofenac to be more efficacious than 100mg rectal indomethacin. Despite these data, there is no conclusive evidence to prove that rectal diclofenac could provide incremental benefits over indomethacin from high-quality randomized, controlled trials. Therefore, the investigators conducted a multicenter, double-blind, randomized, controlled clinical trial to evaluate the efficacy of rectal diclofenac versus indomethacin for the prevention of post-ERCP pancreatitis in average-risk patients.

Detailed Description

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Conditions

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Post-ERCP Acute Pancreatitis NSAIDs Indomethacin Diclofenac Endoscopic Retrograde Cholangiopancreatography

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Participants in the interventional group received 100mg rectal dicfenac
Primary Study Purpose

PREVENTION

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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diclofenac group

Patients without contraindications in diclofenac group received 100mg rectal diclofenac 30 mins before ERCP procedure.

Group Type EXPERIMENTAL

100mg diclofenac

Intervention Type DRUG

All patients without contraindications should receive 100mg rectal diclofenac 30mins before ERCP procedure

Indomethacin group

Patients without contraindications in indomethacin group received 100mg rectal indomethacin 30 mins before ERCP procedure.

Group Type ACTIVE_COMPARATOR

100mg indomethacin

Intervention Type DRUG

All patients without contraindications should receive 100mg rectal indomethacin 30mins before ERCP procedure

Interventions

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100mg diclofenac

All patients without contraindications should receive 100mg rectal diclofenac 30mins before ERCP procedure

Intervention Type DRUG

100mg indomethacin

All patients without contraindications should receive 100mg rectal indomethacin 30mins before ERCP procedure

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* 18-90 years old patients planned to undergo ERCP

Exclusion Criteria

* Allergy to NSAIDs
* The administration of NSAIDs within 7 days
* Not suitable for NSAIDs administration (gastrointestinal hemorrhage within 4 weeks, renal dysfunction \[Cr \>1.4mg/dl=120umol/l\]; presence of coagulopathy before the procedure)
* Previous biliary sphincterotomy and papillary large balloon dilation
* Acute pancreatitis within 3 days before ERCP
* Hemodynamical instability
* Pregnancy or lactation
* Unable to give informed consent
Minimum Eligible Age

18 Years

Maximum Eligible Age

90 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Air Force Military Medical University, China

OTHER

Sponsor Role lead

Responsible Party

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Yanglin Pan

Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Department of gastroenterology, Second Affiliated Hospital of Chongqing Medical University

Chongqing, Chongqing Municipality, China

Site Status

Department of Gastroenterology, Fujian Medical University Xiamen Humanity Hospital

Xiamen, Fujian, China

Site Status

Department of Gastroenterology, The 980th Hospital of the PLA Joint Logistics Support Force

Shijiazhuang, Hebei, China

Site Status

Department of Gastroenterology, Huaihe Hospital of Henan University

Kaifeng, Henan, China

Site Status

Department of Hepatobiliary Surgery, General Hospital of Ningxia Medical University

Yinchuan, Ningxia, China

Site Status

The Second Affiliated Hospital of Xi'an Jiaotong University

Xi'an, Shaanxi, China

Site Status

Department of Gastroenterology,The 986th Hospital of Xijing Hospital

Xi'an, Shaanxi, China

Site Status

Xijing Hospital of Digestive Diseases, Air Force Military Medical University, China

Xi'an, Shaanxi, China

Site Status

Deparment of hepatobiliary surgery, The First Affiliated Hospital Of Xi'an Jiaotong University

Xi'an, Shaanxi, China

Site Status

Department of Gastroenterology and Endoscopy, Department of Gastroenterology and EndoscopyThe Third Affiliated Hospital of Naval Military Medical University

Shanghai, Shanghai Municipality, China

Site Status

Department of Gastroenterology, General Hospital of Xinjiang Military Region

Ürümqi, Xinjiang, China

Site Status

Countries

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China

References

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Cotton PB, Lehman G, Vennes J, Geenen JE, Russell RC, Meyers WC, Liguory C, Nickl N. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc. 1991 May-Jun;37(3):383-93. doi: 10.1016/s0016-5107(91)70740-2.

Reference Type BACKGROUND
PMID: 2070995 (View on PubMed)

Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, Tsiotos GG, Vege SS; Acute Pancreatitis Classification Working Group. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013 Jan;62(1):102-11. doi: 10.1136/gutjnl-2012-302779. Epub 2012 Oct 25.

Reference Type BACKGROUND
PMID: 23100216 (View on PubMed)

Kang X, Guo X, Chen Z, Zhou Z, Luo H, Lu Y, Lou L, Guo X, Pan Y. The Incidence and Severity of Post-ERCP Pancreatitis in Patients Receiving Standard Administration of NSAIDs: a Systematic Review and Meta-analysis. J Gastrointest Surg. 2022 Nov;26(11):2380-2389. doi: 10.1007/s11605-022-05399-6. Epub 2022 Aug 8.

Reference Type BACKGROUND
PMID: 35941494 (View on PubMed)

Akshintala VS, Sperna Weiland CJ, Bhullar FA, Kamal A, Kanthasamy K, Kuo A, Tomasetti C, Gurakar M, Drenth JPH, Yadav D, Elmunzer BJ, Reddy DN, Goenka MK, Kochhar R, Kalloo AN, Khashab MA, van Geenen EJM, Singh VK. Non-steroidal anti-inflammatory drugs, intravenous fluids, pancreatic stents, or their combinations for the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis: a systematic review and network meta-analysis. Lancet Gastroenterol Hepatol. 2021 Sep;6(9):733-742. doi: 10.1016/S2468-1253(21)00170-9. Epub 2021 Jun 30.

Reference Type BACKGROUND
PMID: 34214449 (View on PubMed)

Luo H, Zhao L, Leung J, Zhang R, Liu Z, Wang X, Wang B, Nie Z, Lei T, Li X, Zhou W, Zhang L, Wang Q, Li M, Zhou Y, Liu Q, Sun H, Wang Z, Liang S, Guo X, Tao Q, Wu K, Pan Y, Guo X, Fan D. Routine pre-procedural rectal indometacin versus selective post-procedural rectal indometacin to prevent pancreatitis in patients undergoing endoscopic retrograde cholangiopancreatography: a multicentre, single-blinded, randomised controlled trial. Lancet. 2016 Jun 4;387(10035):2293-2301. doi: 10.1016/S0140-6736(16)30310-5. Epub 2016 Apr 28.

Reference Type BACKGROUND
PMID: 27133971 (View on PubMed)

Kang X, Xia M, Wang J, Wang X, Luo H, Qin W, Liang Z, Zhao G, Yang L, Sun H, Tao J, Ning B, Zhong L, Zhang R, Ma X, Zhao J, Yue L, Jin H, Kang C, Ren G, Liang S, Wang H, Wang L, Nie Y, Wu K, Fan DM, Pan Y. Rectal diclofenac versus indomethacin for prevention of post-ERCP pancreatitis (DIPPP): a multicentre, double-blind, randomised, controlled trial. Gut. 2025 Jun 6;74(7):1094-1102. doi: 10.1136/gutjnl-2024-334466.

Reference Type DERIVED
PMID: 40113243 (View on PubMed)

Other Identifiers

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KY20232165-C-1

Identifier Type: -

Identifier Source: org_study_id

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