Efficacy of intravenous parecoxib in preventing post-endoscopic retrograde cholangiopancreatography pancreatitis: a randomized controlled trial

Abstract

Background and aims: This study aimed to evaluate the efficacy of intravenous (IV) parecoxib in preventing post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis and clinically significant post-ERCP abdominal pain in patients undergoing their first ERCP. Methods: Participants undergoing ERCP with a native papilla were randomly assigned to receive intravenous parecoxib plus standard IV fluid or standard IV fluid alone. Data on patient characteristics, initial serum bilirubin levels, procedural techniques, papilla type, and endoscopic risk factors were collected. The incidence rates of post-ERCP pancreatitis, hyperamylasemia, and post-ERCP abdominal pain were compared between the groups. Results: A total of 83 and 82 patients were included in the parecoxib and control groups, respectively. There were no significant between-group differences in comorbidities, pre-procedure risks, or baseline laboratory results. The most common diagnosis after ERCP was bile duct stones (62%). The incidence of post-ERCP pancreatitis was 2.4% in the parecoxib group and 11.0% in the control group (p = 0.058). The incidence of post-ERCP abdominal pain was significantly lower in the parecoxib group than in the control group at both 4 h (26.5% vs. 52.4%, p = 0.001) and 24 h (6.0% vs. 20.7%, p = 0.011) after the procedure. Conclusions: Intravenous parecoxib was effective in reducing post-ERCP abdominal pain and showed a trend toward a lower incidence of post-ERCP pancreatitis (PEP) in both unselected and high-risk patients, without any serious adverse events. Therefore, intravenous parecoxib may represent a viable alternative for PEP prevention in settings where rectal nonsteroidal anti-inflammatory drugs are unavailable.