Indomethacin plus somatostatin helps avert pancreatitis in ERCP patients

The addition of somatostatin to rectal indomethacin is safe and effective in the prevention of postendoscopic retrograde cholangiopancreatography (post-ERCP) hypermylasemia and pancreatitis (PEP) in high-risk patients, reports a study.

A team of investigators conducted this study to determine the effect of adding intravenous somatostatin to rectal indomethacin on the incidence of PEP in high-risk patients, given the high prevalence and importance of PEP and the controversial findings.

A total of 530 patients underwent ERCP between March 2018 and February 2019. The intervention group received a bolus injection of 250-μg somatostatin, followed by an infusion of 500-μg somatostatin for 2 hours. A control group was also involved. Patients in both arms received 100 mg of pre-ERCP suppository indomethacin. After ERCP, all participants were screened for PEP symptoms and signs.

Of the patients, 376 were included in the final analysis. The most common adverse event was PEP, with a total of 50 episodes (13.2 percent), including 21 mild (5.5 percent), 23 moderate (6.1 percent), and six severe (1.2 percent). PEP rate was lower in the intervention group compared to the control group (11.4 percent vs 15.2 percent; p=0.666).

In addition, the control had a higher incidence of post-ERCP hyperamylasemia than the intervention group (21.7 percent vs 18.2 percent; p=0.395). No death was reported.

“[A]dministration of somatostatin plus indomethacin could safely reduce the rate of post-ERCP hyperamylasemia and PEP in the intervention group compared with the control group, but the differences were not significant,” the authors said.

“Further studies with larger sample sizes are required,” they added.

ERCP is commonly used in the treatment of pancreaticobiliary disorders.