Dr. Nikhil R. Thiruvengadam discusses his manuscript “Rectal Indomethacin Reduces Pancreatitis in High- and Low-Risk Patients Undergoing Endoscopic Retrograde Cholangiopancreatography.” To view abstract www.gastrojournal.org/
I’m doctor there’ve and i’m from the university of pennsylvania and i’m going to talk about our study rectal in the medicine reduces pancreatitis in both high and low res patients undergoing ercp to be published in the journal later this month randall rectal in the medicine was shown a significant benefit in the landmark study by almond certain colleagues done in
June of 2012 it was shown to significantly reduce the rate of pancreatitis and moderate to severe pancreatitis in high-risk patients mainly with sphincter of oddi dysfunction undergoing ercp following the study our center like many others started routinely administering enda medicine falling ercp however the majority of patients undergoing ercp tend to be low to
Average risk and were not representative of this high-risk cohort given this a new medicine has not been shown to be beneficial in this population thus we conducted a real-world k-series retrospective cohort study looking at ret falana medicine and its benefit in reducing pancreatitis and moderate to severe pancreatitis from january 1st 2009 to december 31st 2015
We looked at 4,000 17 patients undergoing ercp from january 1st 2009 to june 1st 2012 no one received into medicine following this with a few exceptions patients received into medicine a primary outcome with the development of post ercp pancreatitis but the cotton consensus criteria and the secondary outcome was a development of moderate severe pancreatitis by
The same criteria a multivariable logistic regression was used to analyze the data to adjust for potential confounders the secondary propensity match analysis was performed to adjust for potential differences in who received into medicine versus those who did not of the 4017 patients 2007 received into medicine compared to 2010 who did not one point 99 percent
Of patients who received into medicine developed pancreatitis compared to four point seven three percent of unexposed patients indomethacin significantly reduced the rates of pancreatitis by almost 65% with an odds ratio of 0.35 it also significant reduce the rates of monitor severe pancreatitis with an odds ratio of 0.17% reduction of large severe pancreatitis
Of 83% the number needed to treat tube you to prevent one case of pancreatitis was 34 and the number needed to treat to prevent one case of mild to severe pancreatitis was 45 for a new medicine both were definitely significant looking at an important subgroup we looked at patients with malignant biliary obstruction we found an interesting finding of a higher rate
In the unexposed cohort than previously thought five point eight seven percent of these patients to bob pancreatitis which is higher than the laura said presumed to have in this subgroup in the medicine significantly reduced pancreatitis by almost sixty four percent with an odds ratio of 0.36 as well as moderate to severe pancreatitis with an odds ratio of zero
Point two zero the number needed to treat to prevent one case of pep in patients with malignant obstruction was 23 and the number need to treat to prevent one case of magis near pancreatitis was 35 we looked at who benefited the most and it seems that patients with pancreatic enter carcinoma where the highest risk and had the most benefit the unexposed cohort these
Patients develop appetizers at almost 7.5% compared to just two point three percent for any medicine a significant risk reduction we also demonstrated in other significant subgroups high-risk patients patients with psc patients with gall stones bile leak as well as a time to benefit in post liver transplant patients in summary our study demonstrated that in both
Low and high risk patients in de medicine significantly reduce a risk of both pancreatitis and moderate to severe pancreatitis interestingly in the subgroup of patients with malignant fillery obstruction they had a much higher rate of pancreatitis than previously thought however in de médecine significantly attenuated this risk also we demonstrated important
Reduction in significant other subgroups including high risk patients and the other subgroups i described our study however had had potential limitations given in fret respective cohort design we potentially could have had other con founders who were unable to adjust for how we try it we performed a propensity match analysis to adjust for differences in who may have
Received in the medicine versus those who did not this confirmed the primary model another potential downside is that our study was performed in a tertiary academic medical care center but the majority of endoscopists work experience and hospice this could have loaded procedural variability and could limit the validity of our study when applied to other populations
In conclusion our study demonstrated three important findings first in all patients both low and high risk patients in de metz and significantly reduces the risk of both pancreatitis and moderate to severe pancreatitis in patients with malignant billy obstruction we showed that the rate of pancreatitis was higher than previously described but in de metz and reduce
The rates of pancreatitis and moderate severe pancreatitis in this approval finally our study suggests that ena medicine should be routinely used following ercp and prospective studies involving rectal and a medicine should be undertaken in both low and high risk patients thank you
Transcribed from video
Rectal Indomethacin Reduces Pancreatitis in High- and Low-Risk Patients Undergoing… By AmerGastroAssn