The incidence of post-ERCP pancreatitis is not reduced in patients given intravenous ketorolac for post-procedural abdominal pain

Abstract

Introduction: Nonsteroidal anti-inflammatory drugs (NSAIDs) (e.g. indomethacin), administered rectally, seem to be effective in reducing post-ERCP pancreatitis (PEP). This effect seems lost with intramuscularly or intravenously administration. Our aim is to assess whether intravenous ketorolac given as an analgesic to patients with post-procedural abdominal pain reduces the rate of PEP. Material and methods: We retrospectively evaluated all hospital in-patients who had undergone therapeutic ERCP in a one-year period, comparing the rates of PEP in those who developed post-ERCP abdominal pain and those who did not. Patients with pain received ketorolac as analgesic NSAID (group A), patients without pain did not (group B). Patients with post-ERCP abdominal pain who were given ketorolac were also compared with those treated with non-NSAIDs because of contraindications. Results and discussion: A total of 587 patients underwent ERCP: 277 had post-procedural abdominal pain (47%), 310 had none. Among patients with pain, the rates of PEP were 7.8% for those given ketorolac and 8.5% for those taking non-NSAIDs (p = 0.79). Comparing groups A and B, the rates of PEP were not significantly different considering both all the patients (respectively 7.8% and 4.2%, p = 0.08) and those at high risk (3.8% and 6%, p = 0.6). In multivariate analysis, only age was significantly associated with PEP (p = 0.03); ketorolac was not (p = 0.16). Conclusions: Intravenous ketorolac to patients with post-ERCP abdominal pain seemed not to reduce the rate of PEP in either the whole group or in patients at high risk for this complication, compared to patients with no post-ERCP pain and no treatment.