Rectal indometacin to prevent hyperamylasemia and pancreatitis following percutaneous biliary stent insertion: a study on propensity matching analysis

doi:10.3877/cma.j.issn.2095-5782.2021.03.010

Abstract

Abstract:

Objective

To explore the effect of preoperative rectal indometacin on preventing hyperamylasemia and pancreatitis following percutaneous biliary stent insertion (PTBS).

Methods

During the period from June 2019 to January 2021, the clinical data of 141 patients with malignant biliary obstruction underwent PTBS in our department were collected. Among them, 29 patients were treated with indometacin rectally and the other 112 patients were included without indometacin. A propensity matching analysis was carried out according to the proportion of 1:4 in the two groups. The levels of serum amylase at 3 h and24 h after the procedure, and the incidence of hyperamylasemia and pancreatitis were compared. The other complications were recorded.

Results

In the present study, a total of 110 patients were matched, including 22 patients in the indometacin group and 88 patients in the untreated group. The baseline data of thetwo groups were comparable. The levels of serum amylase at 3h and 24h after the procedure in the two groups were 45.4 (34.6, 61.1) vs 60.6 (43.2, 104.1) U/L and 43.3 (34.5, 61.8) vs 59.3 (44.2, 76.4) U/L respectively, and the difference between the two groups was statistically significant (P = 0.007, P = 0.026). In addition, the incidence of pancreatitis in the indometacin group (4.5%) was lower than that in the untreated group (13.6%), however, there was no significant statistical difference (P = 0.417). The incidence of postoperative hyperamylasemia was similar between the two groups (9.1%, 11.4%). No indometacin related complications occurred.

Conclusions

Preoperative rectal indometacin can effectively reduce the level of serum amylase in patients following PTBS and is relatively safe, which is worthy of the further clinical study.

Key words: Indometacin, Pancreatitis, Percutaneous transhepatic biliary stent insertion, Malignant biliary obstructive

Chen Xu, Wei Yang, Jianwu Ren, Weizhong Zhou, Sheng Liu, Haibin Shi. Rectal indometacin to prevent hyperamylasemia and pancreatitis following percutaneous biliary stent insertion: a study on propensity matching analysis[J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2021, 09(03): 294-299.

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Figures/Tables 5

References 29

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临床因素		匹配前				匹配后
临床因素		吲哚美辛组（n = 29）	非用药组（n = 112）	t / Z / χ²值	P值	吲哚美辛组（n = 22）	非用药组（n = 88）	t / Z / χ²值	P值
年龄（岁）		68.4 ± 12.4	65.9 ± 10.9	1.073	0.285	67.8 ± 13.4	64.8 ± 10.9	1.107	0.271
性别				0.834	0.361			1.311	0.252
	男	17	55			13	40
	女	12	57			9	48
肿瘤类型				1.028	0.311			0.382	0.537
	胰腺癌	7	18			5	15
	非胰腺癌	22	94			17	73
梗阻部位				1.124	0.570
	肝门部或胆总管上段	12	57			10	42
	胆总管中下段	14	48			10	40
	多段累及	3	7			2	6
术前实验室指标
	AMS （U/L)	35.2（30.4，50.7）	32.1（30.0，41.6）	-1.376	0.169	36.0（50.3，30.5）	32.1（30.0，41.5）	-1.366	0.172
	ALT （U/L)	180.1（308.2，71.8）	156.0（89.5，294.6）	-0.286	0.775	191.7（326.8，107.6）	153.1（80.1，297.9）	-0.859	0.390
	TBIL （μmol/L)	59.5（29.9，96.7）	63.4（37.6，110.3）	-0.908	0.364	72.2（40.9，112.6）	60.3（41.1，110.4）	-0.123	0.902
	WBC （10⁹/L)	5.7（4.9，7.2）	6.9（4.8，9.3）	-1.688	0.091	5.9（4.8，7.5）	6.4（4.7，9.2）	-0.781	0.435
支架数量				1.666	0.435			1.141	0.565
	1	22	75			16	58
	2	5	32			4	25
	≥ 3	2	5			2	5
外引流管植入				0.123	0.726			< 0.001	> 0.999
	是	4	21			4	15
	否	25	91			18	73
碘粒子条植入				9.655	0.002			0.795	0.373
	是	9	10			2	2
	否	20	102			20	86
胰管显影				0.070	0.792			< 0.001	> 0.999
	是	2	12			2	10
	否	27	100			20	78
支架跨十二指肠乳头				0.247	0.619			0.229	0.632
	是	16	56			11	49
	否	13	56			11	39

临床因素		匹配前				匹配后
临床因素		吲哚美辛组（n = 29）	非用药组（n = 112）	t / Z / χ²值	P值	吲哚美辛组（n = 22）	非用药组（n = 88）	t / Z / χ²值	P值
年龄（岁）		68.4 ± 12.4	65.9 ± 10.9	1.073	0.285	67.8 ± 13.4	64.8 ± 10.9	1.107	0.271
性别				0.834	0.361			1.311	0.252
	男	17	55			13	40
	女	12	57			9	48
肿瘤类型				1.028	0.311			0.382	0.537
	胰腺癌	7	18			5	15
	非胰腺癌	22	94			17	73
梗阻部位				1.124	0.570
	肝门部或胆总管上段	12	57			10	42
	胆总管中下段	14	48			10	40
	多段累及	3	7			2	6
术前实验室指标
	AMS （U/L)	35.2（30.4，50.7）	32.1（30.0，41.6）	-1.376	0.169	36.0（50.3，30.5）	32.1（30.0，41.5）	-1.366	0.172
	ALT （U/L)	180.1（308.2，71.8）	156.0（89.5，294.6）	-0.286	0.775	191.7（326.8，107.6）	153.1（80.1，297.9）	-0.859	0.390
	TBIL （μmol/L)	59.5（29.9，96.7）	63.4（37.6，110.3）	-0.908	0.364	72.2（40.9，112.6）	60.3（41.1，110.4）	-0.123	0.902
	WBC （10⁹/L)	5.7（4.9，7.2）	6.9（4.8，9.3）	-1.688	0.091	5.9（4.8，7.5）	6.4（4.7，9.2）	-0.781	0.435
支架数量				1.666	0.435			1.141	0.565
	1	22	75			16	58
	2	5	32			4	25
	≥ 3	2	5			2	5
外引流管植入				0.123	0.726			< 0.001	> 0.999
	是	4	21			4	15
	否	25	91			18	73
碘粒子条植入				9.655	0.002			0.795	0.373
	是	9	10			2	2
	否	20	102			20	86
胰管显影				0.070	0.792			< 0.001	> 0.999
	是	2	12			2	10
	否	27	100			20	78
支架跨十二指肠乳头				0.247	0.619			0.229	0.632
	是	16	56			11	49
	否	13	56			11	39

组别	术前	术后3 h	术后24 h
吲哚美辛组（n = 22）	36.0（50.3，30.5）	45.4（34.6，61.1）	43.3（34.5，61.8）
非用药组（n = 88）	32.1（30.0，41.5）	60.6（43.2，104.1）	59.3（44.2，76.4）
Z值	-1.366	-2.690	-2.220
P值	0.172	0.007	0.026

组别	术前	术后3 h	术后24 h
吲哚美辛组（n = 22）	36.0（50.3，30.5）	45.4（34.6，61.1）	43.3（34.5，61.8）
非用药组（n = 88）	32.1（30.0，41.5）	60.6（43.2，104.1）	59.3（44.2，76.4）
Z值	-1.366	-2.690	-2.220
P值	0.172	0.007	0.026

组别	高淀粉酶血症	胰腺炎	中重度胰腺炎
吲哚美辛组（n = 22）	2（9.1）	1（4.5）	0
非用药组（n = 88）	10（11.4）	12（13.6）	0
χ²值	0.000	0.660	-
P值	> 0.999	0.417	-

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