GIT J club endoscopy December 2014.

1. Endoscopy
articlEs

33.  Eight RCTs &several meta-analyses demonstrated that
rectal (NSAIDs) reduce the risk of (PEP) by about 50%.
 Rectal indomethacin/ diclofenac also reduce the severity of
PEP, effective in both high& average-risk cases
 It is grade A recommendation by the European Society of
GIE for almost all patients undergoing ERCP.
 Although the uptake in clinical practice has been rapid &
widespread, there does appear to be some apprehension
surrounding the rectal mode of administration.

34. Rectal administration is unappealing to some healthcare
providers &may be undesirable to certain patients.
NSAID suppositories are not available on many hospitals,
challenging to obtain& marginally more expensive than their
parenteral counterparts.
Based on available RCT data, only rectal indomethacin or
diclofenac should be prescribed for PEP prevention, as
recommended by existing guidelines