الفهرس 
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Abstract
Acute pancreatitis represents the most serious complication after
ERCP.
The aim of the work was to compare Diclofenac to Allopurinol in
the prevention of post-ERCP acute pancreatitis in a prospective
randomized controlled trial .
Diclofenac 100 mg. suppository, administered once immediately
after ERCP procedure, was proven effective in preventing post-ERCP
pancreatitis in a single center human study (Murray et al. ,2003).
Allopurinol with the usual low dose was previously investigated in
human in prevention of post-ERCP pancreatitis in the following studies
and all have yielded negative results (Clemens et al. ,1991),(Badra et al.
,2000),(Budzynska et al. ,2001), (Romaguolo et al. ,2005), (Mosler et al.
,2005).
Pretreatment with high-dose, orally administered allopurinol
decreases the frequency of post-ERCP pancreatitis (Katsinelos et al.
,2005).
This study was carried on 100 cases, they were divided into 3
groups:
· Group (1): 40 patients who were given Diclofenac 100mg
suppository immediately after ERCP procedure.
· Group (2): 40 patients who were given oral 300 mg allopurinol 1
hour before ERCP procedure .
· Group (3): ”Control group” 20 patients who were not given neither
Diclofenac nor Allopurinol.
All individuals were subjected to the following :
- full history taking and thorough clinical examination.
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Summary and Conclusions
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- Biochemical Liver function tests (Total and Direct bilirubin,
AST, ALT, Alkaline phosphatase, GGT, Albumin).
- Prothrombin concentration.
- Abdominal ultrasound.
- Serum amylase & lipase immediately before ERCP procedure , 4
hours after ERCP procedure and 24 hours after ERCP procedure.
Our results showed that:
- ERCP diagnosis of all patients was : (47 patients had CBD and/or
hilar sones, 31 had stricture, 11 had ampullary mass, 3 had
pancreatic mass, 2 had hilar mass, 3 had biliary leak, 1 had post
cholecystectomy ligation of C.B.D and 6 had Abnormal
configuration of CBD or No identifiable cause).
- The 3 studied groups were comparable as regards sex ( Males in
groups: : Diclofenac group 25/40, Allopurinol group 22/40,
Control group 14/20 , p>0.05 ) ( Females in groups: Diclofenac
group 15/40, Allopurinol group 18/40, Control group 6/20,
p>0.05 ) and age (Diclofenac group 51.83±14.58 years,
Allopurinol group 52.15±12.20 years, Control group 46.95±14.41
years, p>0.05)
- The 3 studied groups were comparable as regards Bilirubin total
and direct, prothrombin concentration, AST, GGT and ALP
(p>0.05) but they were not comparable as regards total protein,
albumin (p<0.01) and ALT (p<0.05).
- There was significant difference between the 3 studied groups as
regards the occurrence of pancreatitis where it was highest in
control group and lowest in the group who took diclofenac
suppository(G1). [8/20 (40%) cases had pancreatitis in control
group. 5/40 (12.5%) patients had pancreatitis in Diclofenac
group. 7/40 (17.5%) patients had pancreatitis in Allopurinol.