A 25 mg rectal dose of diclofenac for prevention of post-ERCP pancreatitis in elderly patients

Abstract

Objectives

A 50–100 mg rectal dose of diclofenac or indomethacin is recommended for prophylaxis of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP); however, limited data are available regarding the appropriate dose to prevent PEP in elderly patients. We aimed to evaluate the efficacy and safety of 25 mg diclofenac in preventing PEP in elderly patients. Material and methods: Overall, 276 patients with naive papilla, aged over 75 years, were included in the present study between April 2013 and March 2020. We retrospectively evaluated the risk of PEP in patients over 75 years, administered with or without 25 mg diclofenac 30 min before ERCP using inverse probability of treatment weighting (IPTW) analysis. Results: Patients were categorized into the diclofenac group (83 patients) or non-diclofenac group (193 patients). The incidence rate of PEP in the diclofenac group was significantly lower than that in the non-diclofenac group (4% vs. 14%, p = .01). Multivariate analysis revealed that 25 mg diclofenac was an independent protective factor against PEP in elderly patients aged over 75 years (odds ratio [OR] = 0.17; 95% confidence interval [CI] = 0.04–0.67; p = 0.01). This protective effect of diclofenac against PEP remained robust after IPTW analysis (OR = 0.11; 95% CI = 0.03–0.40; p = .001). No adverse events related to diclofenac were observed. Conclusion: Diclofenac (25 mg) was considered effective and safe for preventing PEP in elderly patients. Our results may provide a new strategy for preventing PEP in elderly patients.

Keywords:

• NSAIDs
• diclofenac
• post-endoscopic retrograde cholangiopancreatography pancreatitis
• elderly patients
• inverse probability of treatment weighting

Acknowledgements

The authors thank our medical staff who helped with data collection.

Author contributions

Conception and design were done by N. Maeda, A. Higashimori, M. Nakatani. Analysis and interpretation of data were performed by N. Maeda, A. Higashimori, M. Nakatani, Y. Mizuno, Y. Nakamura, D. Ikeda, K. Morimoto. Writing, review, and/or revision of the manuscript were done by N. Maeda, A. Higashimori, H. Maruyama, T. Watanabe. Study supervision was performed by M. Nakatani, T. Fukuda, Y. Fujiwara. All authors reviewed and approved the final manuscript.

Disclosure statement

All authors declare that they have no conflict of interest.

Additional information

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.