Rectal Indomethacin plus Lactated Ringer's for Prophylaxis of Post-ERCP Pancreatitis in Children.

IF 1.2 4区医学 Q4 GASTROENTEROLOGY & HEPATOLOGY

Acta gastro-enterologica Belgica Pub Date : 2026-01-01 DOI:10.51821/89.1.15113

A Islek, T Sayar, A S Ala, O Uskudar, U Karaogullarindan, G Tumgor

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引用次数: 0

Abstract

Background and study aims: Pediatric data on post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) prophylaxis remains limited. This study evaluated the effectiveness and safety of combined rectal indomethacin and lactated Ringer's (LR) as prophylaxis for PEP in children undergoing ERCP.

Patients and methods: We retrospectively reviewed all pediatric ERCPs performed at a single tertiary center (2012- 2025). The study group consisted of procedures performed after 2021, when a standardized prophylaxis protocol (100 mg rectal indomethacin before ERCP plus LR at 2.5 L·m-2, started 2 hours before and continued 6 hours after) was implemented. Procedures performed before 2021 served as the control group. Primary and secondary endpoints were the development of PEP and cholangitis, respectively. Analyses considered American Society for Gastrointestinal Endoscopy (ASGE) procedural complexity, stent placement/type, and naive papilla status.

Results: Seventy-five children underwent 95 ERCPs (prophylaxis group: 23 patients/38 procedures; control group: 55 patients/65 procedures). Baseline demographic and procedural characteristics were similar between the prophylaxis and control groups. Post-ERCP pancreatitis developed in 13.2% of procedures in the prophylaxis group and 13.8% in the control group (RD -0.7%; 95% CI -18.5 to 19.9; p = 1.000). Cholangitis developed in 5.3% of procedures in the prophylaxis group and 7.7% in the control group (RD -2.4%; 95% CI -15.3 to 14.0; p = 1.000). Adjustment for stent type did not meaningfully alter the associations between prophylaxis and outcomes. All PEP cases were mild to moderate. No treatment-related adverse events-including indomethacin-associated gastrointestinal or renal complications, or fluid-overload events-were observed in either group.

Conclusions: Combined rectal indomethacin plus LR was feasible and well tolerated in pediatric ERCP but did not significantly reduce PEP or cholangitis. These findings highlight the need for larger, multicenter pediatric trials to define optimal prophylaxis.

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直肠吲哚美辛加乳酸林格氏预防ercp后儿童胰腺炎。

背景和研究目的：儿童内镜后逆行胰胆管造影（ERCP）预防胰腺炎（PEP）的数据仍然有限。本研究评估了直肠吲哚美辛联合乳酸林格（LR）预防ERCP患儿PEP的有效性和安全性。患者和方法：我们回顾性地回顾了2012- 2025年在单一三级中心进行的所有儿科ercp。研究组由2021年之后实施的手术组成，当时实施了标准化的预防方案（ERCP前100mg直肠吲哚美辛加2.5 L·m-2的LR，前2小时开始，后6小时继续）。2021年之前进行的手术作为对照组。主要和次要终点分别是PEP和胆管炎的发展。分析考虑了美国胃肠内窥镜学会（ASGE）手术的复杂性、支架放置/类型和初始乳头状态。结果：75名儿童接受了95次ercp治疗（预防组23例/38次手术；对照组55例/65次手术）。预防组和对照组的基线人口统计学和程序特征相似。ercp术后胰腺炎发生率在预防组为13.2%，对照组为13.8% （RD -0.7%; 95% CI -18.5至19.9;p = 1.000）。预防组5.3%的手术发生胆管炎，对照组7.7% （RD -2.4%; 95% CI -15.3 ~ 14.0; p = 1.000）。支架类型的调整并没有改变预防和预后之间的关系。所有PEP病例均为轻至中度。两组均未观察到与治疗相关的不良事件，包括吲哚美辛相关的胃肠道或肾脏并发症，或液体超载事件。结论：直肠吲哚美辛联合LR治疗小儿ERCP是可行且耐受性良好的，但不能显著降低PEP或胆管炎。这些发现强调需要更大的、多中心的儿科试验来确定最佳预防措施。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Acta gastro-enterologica Belgica Medicine-Gastroenterology

CiteScore

2.30

自引率

20.00%

发文量

期刊介绍： The Journal Acta Gastro-Enterologica Belgica principally publishes peer-reviewed original manuscripts, reviews, letters to editors, book reviews and guidelines in the field of clinical Gastroenterology and Hepatology, including digestive oncology, digestive pathology, as well as nutrition. Pure animal or in vitro work will not be considered for publication in the Journal. Translational research papers (including sections of animal or in vitro work) are considered by the Journal if they have a clear relationship to or relevance for clinical hepato-gastroenterology (screening, disease mechanisms and/or new therapies). Case reports and clinical images will be accepted if they represent an important contribution to the description, the pathogenesis or the treatment of a specific gastroenterology or liver problem. The language of the Journal is English. Papers from any country will be considered for publication. Manuscripts submitted to the Journal should not have been published previously (in English or any other language), nor should they be under consideration for publication elsewhere. Unsolicited papers are peer-reviewed before it is decided whether they should be accepted, rejected, or returned for revision. Manuscripts that do not meet the presentation criteria (as indicated below) will be returned to the authors. Papers that go too far beyond the scope of the journal will be also returned to the authors by the editorial board generally within 2 weeks. The Journal reserves the right to edit the language of papers accepted for publication for clarity and correctness, and to make formal changes to ensure compliance with AGEB’s style. Authors have the opportunity to review such changes in the proofs.