PREDICTIVE FACTORS FOR PROPHYLAXIS EFFECT OF NAPROXEN IN POST ENDOSCOPIC PANCREATITIS
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) can be associated with complications like post-ERCP pancreatitis (PEP). We aimed to examine the possible influence of selective demographic and clinical factors on efficacy of periprocedural 500 mg Naproxen single dose rectal administration in prevention of PEP in patients after diagnostic or therapeutic ERCP. This randomized prospective mono-centric clinical study was implemented during January-April 2022 on 30 patients referred for ERCP at the University Clinical Center of Kosovo-Prishtina. Before ERCP, all patients received periprocedural 500mg Naproxen single dose rectal administration in prevention of PEP. The levels of amylase, lipase, and CRP were measured before ERCP, and 4/24h after. The incidence of PEP was 16,67% (5/ 30) – 2 (11,76%) of the male and 3 (23,08%) of the female (p=0,4101). No significant differences between the patients without/with PEP was found related to age (p=0,8674), BMI (p=0,5591) and duration of procedure (p=0,5590). Pancreatic duct wire cannulation happened in 5 (16,67%) patients, while only 2 (40%) of them developed PEP. Amylases levels 24h after ERCP were significantly higher in patients with PEP (p=0,0005). Between patients without/with PEP there were significant differences in lipase levels before/4h/24h after ERCP for p=0,0451 vs. p=0,0278 vs. p=0,005 respectively. Related to CRP levels, no significant difference was found between the groups at any measurement time. Analyzed potential influencing factors didn’t show significant influence on efficacy of Naproxen in prevention of PEP after ERCP. More extensive controlled trials are underway in Republic of Kosovo to precise the effects of Naproxen in reduction of PEP after ERCP.
Key words: Naproxen; nonsteroidal anti-inflammatorydrugs; pancreatic duct cannulation; post-endoscopicretrograde cholangiopancreatography; pancreatitis;
References
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5. Gewirtz AT, Collier-Hyams LS, Young AN, Kucharzik T, Guilford WJ, Parkinson JF, Williams IR, Neish AS, Madara JL. Lipoxin a4 analogs attenuate induction of intestinal epithelial proinflammatory gene expression and reduce the severity of dextran sodium sulfate-induced colitis. J Immunol. 2002 May 15;168(10):5260-7. doi: 10.4049/jimmunol.168.10.5260. PMID: 11994483.
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7. Freeman ML, Nelson DB, Sherman S, Haber GB, Herman ME, Dorsher PJ, Moore JP, Fennerty MB, Ryan ME, Shaw MJ, Lande JD, Pheley AM. Complications of endoscopic biliary sphincterotomy. N Engl J Med. 1996 Sep 26;335(13):909-18. doi: 10.1056/NEJM199609263351301. PMID: 8782497.
8. Masci E, Toti G, Mariani A, Curioni S, Lomazzi A, Dinelli M, Minoli G, Crosta C, Comin U, Fertitta A, Prada A, Passoni GR, Testoni PA. Complications of diagnostic and therapeutic ERCP: a prospective multicenter study. Am J Gastroenterol. 2001 Feb;96(2):417-23. doi: 10.1111/j.1572-0241.2001.03594.x. PMID: 11232684.
9. Cotton PB, Lehman G, Vennes J, et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointestinal Endoscopy. 1991 May-Jun;37(3):383-393. DOI: 10.1016/s0016-5107(91)70740-2. PMID: 2070995.
10. Cotton PB. Outcomes of endoscopy procedures: struggling towards definitions. Gastrointest Endosc. 1994 Jul-Aug;40(4):514-8. doi: 10.1016/s0016-5107(94)70228-4. PMID: 7926553.
11. Messmann H, Vogt W, Holstege A, Lock G, Heinisch A, von Fürstenberg A, Leser HG, Zirngibl H, Schölmerich J. Post-ERP pancreatitis as a model for cytokine induced acute phase response in acute pancreatitis. Gut. 1997 Jan;40(1):80-5. doi: 10.1136/gut.40.1.80. PMID: 9155580; PMCID: PMC1027012.
12. Barthet M, Lesavre N, Desjeux A, Gasmi M, Berthezene P, Berdah S, Viviand X, Grimaud JC. Complications of endoscopic sphincterotomy: results from a single tertiary referral center. Endoscopy. 2002 Dec;34(12):991-7. doi: 10.1055/s-2002-35834. PMID: 12471544.
13. Köklü S, Parlak E, Yüksel O, Sahin B. Endoscopic retrograde cholangiopancreatography in the elderly: a prospective and comparative study. Age Ageing. 2005 Nov;34(6):572-7. doi: 10.1093/ageing/afi180. PMID: 16267181.
14. Katsinelos P, Lazaraki G, Chatzimavroudis G, Terzoudis S, Gatopoulou A, Xanthis A, Anastasiadis S, Anastasiadou K, Georgakis N, Tzivras D, Kountouras J. The impact of age on the incidence and severity of post-endoscopic retrograde cholangiopancreatography pancreatitis. Ann Gastroenterol. 2018 Jan-Feb;31(1):96-101. doi: 10.20524/aog.2018.0203. Epub 2017 Oct 18. PMID: 29333073; PMCID: PMC5759619.
15. Mohammad Alizadeh AH, Abbasinazari M, Hatami B, Abdi S, Ahmadpour F, Dabir S, Nematollahi A, Fatehi S, Pourhoseingholi MA. Comparison of rectal indomethacin, diclofenac, and naproxen for the prevention of post endoscopic retrograde cholangiopancreatography pancreatitis. Eur J Gastroenterol Hepatol. 2017 Mar;29(3):349-354. doi: 10.1097/MEG.0000000000000787. PMID: 27849643.
16. Kawaguchi Y, Ogawa M, Omata F, Ito H, Shimosegawa T, Mine T. Randomized controlled trial of pancreatic stenting to prevent pancreatitis after endoscopic retrograde cholangiopancreatography. World J Gastroenterol. 2012 Apr 14;18(14):1635-41. doi: 10.3748/wjg.v18.i14.1635. PMID: 22529693; PMCID: PMC3325530.
17. Mansour-Ghanaei F, Joukar F, Taherzadeh Z, Sokhanvar H, Hasandokht T. Suppository naproxen reduces incidence and severity of post-endoscopic retrograde cholangiopancreatography pancreatitis: Randomized controlled trial. World J Gastroenterol. 2016 Jun 7;22(21):5114-21. doi: 10.3748/wjg.v22.i21.5114. PMID: 27275104; PMCID: PMC4886387.
18. Classen M, Demling L. Endoskopische Sphinkterotomie der Papilla Vateri und Steinextraktion aus dem Ductus choledochus [Endoscopic sphincterotomy of the papilla of vater and extraction of stones from the choledochal duct (author's transl)]. Dtsch Med Wochenschr. 1974 Mar 15;99(11):496-7. German. doi: 10.1055/s-0028-1107790. PMID: 4835515.
19. Kawai K, Akasaka Y, Murakami K, Tada M, Koli Y. Endoscopic sphincterotomy of the ampulla of Vater. Gastrointest Endosc. 1974 May;20(4):148-51. doi: 10.1016/s0016-5107(74)73914-1. PMID: 4825160.
20. El Nakeeb A, El Hanafy E, Salah T, Atef E, Hamed H, Sultan AM, Hamdy E, Said M, El Geidie AA, Kandil T, El Shobari M, El Ebidy G. Post-endoscopic retrograde cholangiopancreatography pancreatitis: Risk factors and predictors of severity. World J Gastrointest Endosc. 2016 Nov 16;8(19):709-715. doi: 10.4253/wjge.v8.i19.709. PMID: 27909551; PMCID: PMC5114460.
21. Tryliskyy Y, Bryce GJ. Post-ERCP pancreatitis: Pathophysiology, early identification and risk stratification. Adv Clin Exp Med. 2018 Jan;27(1):149-154. doi: 10.17219/acem/66773. PMID: 29521055.Ahmad W, Okam NA, Torrilus C, Rana D, Khatun MK, Jahan N. Pharmacological Prevention of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis: Where Do We Stand Now? Cureus. 2020 Aug 29;12(8):e10115. doi: 10.7759/cureus.10115. PMID: 33005532; PMCID: PMC7523742.
22. El Nakeeb A, El Hanafy E, Salah T, Atef E, Hamed H, Sultan AM, Hamdy E, Said M, El Geidie AA, Kandil T, El Shobari M, El Ebidy G. Post-endoscopic retrograde cholangiopancreatography pancreatitis: Risk factors and predictors of severity. World J Gastrointest Endosc. 2016 Nov 16;8(19):709-715. doi: 10.4253/wjge.v8.i19.709. PMID: 27909551; PMCID: PMC5114460.
23. Mansour-ghanaei, Fariborz & Joukar, Farahnaz & Khalesi, Ali & Naghipour, Mohammadreza & Sepehrimanesh, Masood & Mojtahedi, Kourosh & Yeganeh, Sara & Saedi, Hamid & Asl, Saba. (2020). Naproxen, isosorbide dinitrate and co-administration cannot prevent post-endoscopic retrograde cholangiopancreatography pancreatitis: Randomized controlled trial. Annals of Hepato-Biliary-Pancreatic Surgery. 24. 259-268. 10.14701/ahbps.2020.24.3.259.
24. Abdelfatah MM, Koutlas NJ, Gochanour E, Hamed A, Ibrahim M, Barakat M, Mudireddy PR. Impact of body mass index on the incidence and severity of post-endoscopic retrograde cholangiopancreatography pancreatitis. Ann Gastroenterol. 2019 May-Jun;32(3):298-302. doi: 10.20524/aog.2019.0367. Epub 2019 Mar 12. PMID: 31040628; PMCID: PMC6479648.
25. Hatami B, Kashfi SMH, Abbasinazari M, Nazemalhosseini Mojarad E, Pourhoseingholi MA, Zali MR, Mohammad Alizadeh AH. Epinephrine in the Prevention of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis: A Preliminary Study. Case Rep Gastroenterol. 2018 Apr 13;12(1):125-136. doi: 10.1159/000479494. PMID: 29805355; PMCID: PMC5968254.
26. Testoni PA, Caporuscio S, Bagnolo F, Lella F. Twenty-four-hour serum amylase predicting pancreatic reaction after endoscopic sphincterotomy. Endoscopy. 1999 Feb;31(2):131-6. doi: 10.1055/s-1999-13660. PMID: 10223361.
27. Tadehara M, Okuwaki K, Imaizumi H, Kida M, Iwai T, Yamauchi H, Kaneko T, Hasegawa R, Miyata E, Kawaguchi Y, Masutani H, Koizumi W. Usefulness of serum lipase for early diagnosis of post-endoscopic retrograde cholangiopancreatography pancreatitis. World J Gastrointest Endosc. 2019 Sep 16;11(9):477-485. doi: 10.4253/wjge.v11.i9.477. PMID: 31558969; PMCID: PMC6755082.
28. Ka Kaw M, Singh S. Serum lipase, C-reactive protein, and interleukin-6 levels in ERCP-induced pancreatitis. Gastrointest Endosc. 2001 Oct;54(4):435-40. doi: 10.1067/mge.2001.117763. PMID: 11577303.w M, Singh S. Serum lipase, C-reactive protein, and interleukin-6 levels in ERCP-induced pancreatitis. Gastrointest Endosc. 2001 Oct;54(4):435-40. doi: 10.1067/mge.2001.117763. PMID: 11577303.
2. Pekgöz M. Post-endoscopic retrograde cholangiopancreatography pancreatitis: A systematic review for prevention and treatment. World J Gastroenterol. 2019 Aug 7;25(29):4019-4042. doi: 10.3748/wjg.v25.i29.4019. PMID: 31413535; PMCID: PMC6689803.
3. Dumonceau JM, Andriulli A, Elmunzer BJ, Mariani A, Meister T, Deviere J, Marek T, Baron TH, Hassan C, Testoni PA, Kapral C; European Society of Gastrointestinal Endoscopy. Prophylaxis of post-ERCP pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - updated June 2014. Endoscopy. 2014 Sep;46(9):799-815. doi: 10.1055/s-0034-1377875. Epub 2014 Aug 22. PMID: 25148137.
4. Abbasinazari M, Mohammad Alizadeh AH, Moshiri K, Pourhoseingholi MA, Zali MR. Does allopurinol prevent post endoscopic retrograde cholangio- pancreatography pancreatitis? A randomized double blind trial. Acta Med Iran. 2011;49(9):579-83. PMID: 22052140.
5. Gewirtz AT, Collier-Hyams LS, Young AN, Kucharzik T, Guilford WJ, Parkinson JF, Williams IR, Neish AS, Madara JL. Lipoxin a4 analogs attenuate induction of intestinal epithelial proinflammatory gene expression and reduce the severity of dextran sodium sulfate-induced colitis. J Immunol. 2002 May 15;168(10):5260-7. doi: 10.4049/jimmunol.168.10.5260. PMID: 11994483.
6. Russell CD, Schwarze J. The role of pro-resolution lipid mediators in infectious disease. Immunology. 2014 Feb;141(2):166-73. doi: 10.1111/imm.12206. PMID: 24400794; PMCID: PMC3904237.
7. Freeman ML, Nelson DB, Sherman S, Haber GB, Herman ME, Dorsher PJ, Moore JP, Fennerty MB, Ryan ME, Shaw MJ, Lande JD, Pheley AM. Complications of endoscopic biliary sphincterotomy. N Engl J Med. 1996 Sep 26;335(13):909-18. doi: 10.1056/NEJM199609263351301. PMID: 8782497.
8. Masci E, Toti G, Mariani A, Curioni S, Lomazzi A, Dinelli M, Minoli G, Crosta C, Comin U, Fertitta A, Prada A, Passoni GR, Testoni PA. Complications of diagnostic and therapeutic ERCP: a prospective multicenter study. Am J Gastroenterol. 2001 Feb;96(2):417-23. doi: 10.1111/j.1572-0241.2001.03594.x. PMID: 11232684.
9. Cotton PB, Lehman G, Vennes J, et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointestinal Endoscopy. 1991 May-Jun;37(3):383-393. DOI: 10.1016/s0016-5107(91)70740-2. PMID: 2070995.
10. Cotton PB. Outcomes of endoscopy procedures: struggling towards definitions. Gastrointest Endosc. 1994 Jul-Aug;40(4):514-8. doi: 10.1016/s0016-5107(94)70228-4. PMID: 7926553.
11. Messmann H, Vogt W, Holstege A, Lock G, Heinisch A, von Fürstenberg A, Leser HG, Zirngibl H, Schölmerich J. Post-ERP pancreatitis as a model for cytokine induced acute phase response in acute pancreatitis. Gut. 1997 Jan;40(1):80-5. doi: 10.1136/gut.40.1.80. PMID: 9155580; PMCID: PMC1027012.
12. Barthet M, Lesavre N, Desjeux A, Gasmi M, Berthezene P, Berdah S, Viviand X, Grimaud JC. Complications of endoscopic sphincterotomy: results from a single tertiary referral center. Endoscopy. 2002 Dec;34(12):991-7. doi: 10.1055/s-2002-35834. PMID: 12471544.
13. Köklü S, Parlak E, Yüksel O, Sahin B. Endoscopic retrograde cholangiopancreatography in the elderly: a prospective and comparative study. Age Ageing. 2005 Nov;34(6):572-7. doi: 10.1093/ageing/afi180. PMID: 16267181.
14. Katsinelos P, Lazaraki G, Chatzimavroudis G, Terzoudis S, Gatopoulou A, Xanthis A, Anastasiadis S, Anastasiadou K, Georgakis N, Tzivras D, Kountouras J. The impact of age on the incidence and severity of post-endoscopic retrograde cholangiopancreatography pancreatitis. Ann Gastroenterol. 2018 Jan-Feb;31(1):96-101. doi: 10.20524/aog.2018.0203. Epub 2017 Oct 18. PMID: 29333073; PMCID: PMC5759619.
15. Mohammad Alizadeh AH, Abbasinazari M, Hatami B, Abdi S, Ahmadpour F, Dabir S, Nematollahi A, Fatehi S, Pourhoseingholi MA. Comparison of rectal indomethacin, diclofenac, and naproxen for the prevention of post endoscopic retrograde cholangiopancreatography pancreatitis. Eur J Gastroenterol Hepatol. 2017 Mar;29(3):349-354. doi: 10.1097/MEG.0000000000000787. PMID: 27849643.
16. Kawaguchi Y, Ogawa M, Omata F, Ito H, Shimosegawa T, Mine T. Randomized controlled trial of pancreatic stenting to prevent pancreatitis after endoscopic retrograde cholangiopancreatography. World J Gastroenterol. 2012 Apr 14;18(14):1635-41. doi: 10.3748/wjg.v18.i14.1635. PMID: 22529693; PMCID: PMC3325530.
17. Mansour-Ghanaei F, Joukar F, Taherzadeh Z, Sokhanvar H, Hasandokht T. Suppository naproxen reduces incidence and severity of post-endoscopic retrograde cholangiopancreatography pancreatitis: Randomized controlled trial. World J Gastroenterol. 2016 Jun 7;22(21):5114-21. doi: 10.3748/wjg.v22.i21.5114. PMID: 27275104; PMCID: PMC4886387.
18. Classen M, Demling L. Endoskopische Sphinkterotomie der Papilla Vateri und Steinextraktion aus dem Ductus choledochus [Endoscopic sphincterotomy of the papilla of vater and extraction of stones from the choledochal duct (author's transl)]. Dtsch Med Wochenschr. 1974 Mar 15;99(11):496-7. German. doi: 10.1055/s-0028-1107790. PMID: 4835515.
19. Kawai K, Akasaka Y, Murakami K, Tada M, Koli Y. Endoscopic sphincterotomy of the ampulla of Vater. Gastrointest Endosc. 1974 May;20(4):148-51. doi: 10.1016/s0016-5107(74)73914-1. PMID: 4825160.
20. El Nakeeb A, El Hanafy E, Salah T, Atef E, Hamed H, Sultan AM, Hamdy E, Said M, El Geidie AA, Kandil T, El Shobari M, El Ebidy G. Post-endoscopic retrograde cholangiopancreatography pancreatitis: Risk factors and predictors of severity. World J Gastrointest Endosc. 2016 Nov 16;8(19):709-715. doi: 10.4253/wjge.v8.i19.709. PMID: 27909551; PMCID: PMC5114460.
21. Tryliskyy Y, Bryce GJ. Post-ERCP pancreatitis: Pathophysiology, early identification and risk stratification. Adv Clin Exp Med. 2018 Jan;27(1):149-154. doi: 10.17219/acem/66773. PMID: 29521055.Ahmad W, Okam NA, Torrilus C, Rana D, Khatun MK, Jahan N. Pharmacological Prevention of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis: Where Do We Stand Now? Cureus. 2020 Aug 29;12(8):e10115. doi: 10.7759/cureus.10115. PMID: 33005532; PMCID: PMC7523742.
22. El Nakeeb A, El Hanafy E, Salah T, Atef E, Hamed H, Sultan AM, Hamdy E, Said M, El Geidie AA, Kandil T, El Shobari M, El Ebidy G. Post-endoscopic retrograde cholangiopancreatography pancreatitis: Risk factors and predictors of severity. World J Gastrointest Endosc. 2016 Nov 16;8(19):709-715. doi: 10.4253/wjge.v8.i19.709. PMID: 27909551; PMCID: PMC5114460.
23. Mansour-ghanaei, Fariborz & Joukar, Farahnaz & Khalesi, Ali & Naghipour, Mohammadreza & Sepehrimanesh, Masood & Mojtahedi, Kourosh & Yeganeh, Sara & Saedi, Hamid & Asl, Saba. (2020). Naproxen, isosorbide dinitrate and co-administration cannot prevent post-endoscopic retrograde cholangiopancreatography pancreatitis: Randomized controlled trial. Annals of Hepato-Biliary-Pancreatic Surgery. 24. 259-268. 10.14701/ahbps.2020.24.3.259.
24. Abdelfatah MM, Koutlas NJ, Gochanour E, Hamed A, Ibrahim M, Barakat M, Mudireddy PR. Impact of body mass index on the incidence and severity of post-endoscopic retrograde cholangiopancreatography pancreatitis. Ann Gastroenterol. 2019 May-Jun;32(3):298-302. doi: 10.20524/aog.2019.0367. Epub 2019 Mar 12. PMID: 31040628; PMCID: PMC6479648.
25. Hatami B, Kashfi SMH, Abbasinazari M, Nazemalhosseini Mojarad E, Pourhoseingholi MA, Zali MR, Mohammad Alizadeh AH. Epinephrine in the Prevention of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis: A Preliminary Study. Case Rep Gastroenterol. 2018 Apr 13;12(1):125-136. doi: 10.1159/000479494. PMID: 29805355; PMCID: PMC5968254.
26. Testoni PA, Caporuscio S, Bagnolo F, Lella F. Twenty-four-hour serum amylase predicting pancreatic reaction after endoscopic sphincterotomy. Endoscopy. 1999 Feb;31(2):131-6. doi: 10.1055/s-1999-13660. PMID: 10223361.
27. Tadehara M, Okuwaki K, Imaizumi H, Kida M, Iwai T, Yamauchi H, Kaneko T, Hasegawa R, Miyata E, Kawaguchi Y, Masutani H, Koizumi W. Usefulness of serum lipase for early diagnosis of post-endoscopic retrograde cholangiopancreatography pancreatitis. World J Gastrointest Endosc. 2019 Sep 16;11(9):477-485. doi: 10.4253/wjge.v11.i9.477. PMID: 31558969; PMCID: PMC6755082.
28. Ka Kaw M, Singh S. Serum lipase, C-reactive protein, and interleukin-6 levels in ERCP-induced pancreatitis. Gastrointest Endosc. 2001 Oct;54(4):435-40. doi: 10.1067/mge.2001.117763. PMID: 11577303.w M, Singh S. Serum lipase, C-reactive protein, and interleukin-6 levels in ERCP-induced pancreatitis. Gastrointest Endosc. 2001 Oct;54(4):435-40. doi: 10.1067/mge.2001.117763. PMID: 11577303.
Published
2022-08-31
How to Cite
TANAJ, Halil Nebih; KONDOV, Goran; KRASNIQI, Shaip.
PREDICTIVE FACTORS FOR PROPHYLAXIS EFFECT OF NAPROXEN IN POST ENDOSCOPIC PANCREATITIS.
Journal of Morphological Sciences, [S.l.], v. 5, n. 2, p. 17-24, aug. 2022.
ISSN 2545-4706.
Available at: <http://jms.mk/jms/article/view/vol5no2-4>. Date accessed: 31 mar. 2025.
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