indomethacin-with-or-without-prophylactic-pancreatic-stent-placement-to-prevent-pancreatitis-after-ercp-a-randomised-non-inferiority-trial 2024-01-12T15:19:06.52Z 324813be-a93e-485a-89bd-8464e4a412e0 mas_evidence_types:Randomised%20controlled%20trials Primary research Non-inferiority trial (n=1950) found rectal indomethacin alone was not as effective as indomethacin plus prophylactic pancreatic stent placement to prevent pancreatitis following ERCP (14.9% v 11.3%, respectively; risk difference 3.6%; 95% CI 0.6–6.6; p=0.18 for non-inferiority). <p>An editorial notes this was a pragmatic trial, with no standardisation of the pancreatic duct stent placement, duration of attempts to place the stent, nor the type of stent used. However, the 20 centres included are all referral centres, performing a high volume of complex ERCP, and they caution against routine attempts of pancreatic duct stent prophylaxis among lower-volume endoscopists.</p> <p>According to the editorial, progress is being made with the use of NSAIDS, fluids, pancreatic duct stents, and the judicious use of ERCP itself. The authors say that further well-designed trials are needed to determine the relative benefits of these interventions when combined in the prevention of post-ERCP pancreatitis, and they anticipate that novel pharmacological therapy will be necessary for further major decreases in rates of this condition.</p> https://www.medicinesresources.nhs.uk/indomethacin-with-or-without-prophylactic-pancreatic-stent-placement-to-prevent-pancreatitis-after-ercp-a-randomised-non-inferiority-trial.html <p><a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)02719-8/fulltext">Comment</a></p> https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)02356-5/fulltext 2024-01-11T00:00:00Z 2024-01-12T15:16:50.987Z