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• W2977702918 abstract "Introduction: Post-ERCP pancreatitis (PEP) is not an uncommon complication after endoscopic retrograde cholangiopancreatography (ERCP) with incidence rate ranges from 1-40%. Cyclooxygenase 1 and 2 inhibition is the basis for non-steroidal anti-inflammatory drugs in preventing PEP. Rectal indomethacin was proved by randomized trial to reduce PEP. Intravenous (IV) toradol is potentially superior to other NSAIDs since it is easier to administer, more convenient to use and has better predicted bioavailability and higher potency. Objective: to test the effectiveness of IV toradol in reducing PEP and to identify isolated risk factors for PEP in an average case volume tertiary center. Methods: Retrospective case-control chart review of all adult patients who had their ERCP procedure at St. John Hospital and Medical Center between June 1st, 2011 and March 1st, 2014.To maintain statistical independence, only the first ERCP procedure per each patient was included. Intervention phase was started on June 1st, 2012, during which every patient received an injection of IV toradol prior to ERCP. Patients who did not receive IV toradol during the intervention phase were excluded. PEP was defined by the consensus criteria definition as any new or worsening abdominal pain associated with amylase and/or lipase levels three times normal levels 24 hours after the procedure, and requiring more than one night of inpatient management. We calculated pre-procedure risk score for each patient by modeling risk-scoring systems used in other studies. PEP cases were identified by reviewing patients’ electronic charts. We recorded various demographic data, pertinent medical history and ERCP-procedural details and compared these variables between patients who had PEP and those who did not in order to identify isolated risk factors for PEP. Results: Out of 210 ERCP procedures performed on 210 different patients during the study period, only 8 patients were excluded. The majority of patients were intermediate-high risk. There was no significant difference in PEP rate between patients who received IV toradol and those who did not receive IV toradol ( 7/91, 7.7% ) vs. ( 13/111, 11.7% ) respectively (p=0.47). Suspected sphincter of Oddi dysfunction, biliary sphinctor manometry and higher risk scores were significantly associated with PEP. Patients with higher total bilirubin levels had significantly lower PEP rate. Expert ERCP operators had lower PEP rates compared to less experienced operators. Regression analysis identified biliary sphinctor manometry and procedure operator as best two predictors for PEP. Conclusion: IV toradol did not lower PEP rate significantly. Multi-center randomized trials might be necessary." @default.
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• W2977702918 date "2014-10-01" @default.
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• W2977702918 title "Does Intravenous Toradol Lower the Risk for Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis?" @default.
• W2977702918 doi "https://doi.org/10.14309/00000434-201410002-01948" @default.
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