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COX-2 Inhibitor to Prevent Post-ERCP Pancreatitis

Primary Purpose

Pancreatitis, Acute

Status
Unknown status
Phase
Phase 4
Locations
Study Type
Interventional
Intervention
Cox-2
Indomethacin
Sponsored by
First Affiliated Hospital Xi'an Jiaotong University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Pancreatitis, Acute focused on measuring COX-2, ERCP, Pancreatitis

Eligibility Criteria

18 Years - 80 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Patients undergoing diagnostic or therapeutic ERCP

Exclusion Criteria:

  • Unwillingness or inability to consent for the study
  • Age < 18 years old
  • Intrauterine pregnancy
  • Breastfeeding mother
  • Standard contraindications to ERCP
  • Renal failure (Cr >1.4mg/dl=120umol/l)
  • Acute pancreatitis within 72 hours
  • Known pancreatic head mass
  • Subject with prior biliary sphincterotomy now scheduled for repeat biliary therapy without anticipated pancreatogram
  • ERCP for biliary stent removal or exchange without anticipated pancreatogram;
  • Known active cardiovascular or cerebrovascular disease.
  • Presence of coagulopathy before the procedure or received anticoagulation therapy within three days before the procedure;

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm Type

    Experimental

    Active Comparator

    Arm Label

    Cox-2

    Indomethacin

    Arm Description

    Cox-2 inhibitor ParecoxibNa 40mg pre-ERCP injection

    Rectal Indomethacin was administrated immediately after ERCP in high-risk patients, while average risk patients did not.

    Outcomes

    Primary Outcome Measures

    Post-ERCP Pancreatitis

    Secondary Outcome Measures

    Moderate-to-severe Pancreatitis

    Full Information

    First Posted
    October 30, 2016
    Last Updated
    November 13, 2016
    Sponsor
    First Affiliated Hospital Xi'an Jiaotong University
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    1. Study Identification

    Unique Protocol Identification Number
    NCT02964403
    Brief Title
    COX-2 Inhibitor to Prevent Post-ERCP Pancreatitis
    Official Title
    Effect Observation Study of COX-2 Inhibitor to Prevent Post-ERCP Pancreatitis
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    November 2016
    Overall Recruitment Status
    Unknown status
    Study Start Date
    December 2016 (undefined)
    Primary Completion Date
    February 2018 (Anticipated)
    Study Completion Date
    August 2018 (Anticipated)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Principal Investigator
    Name of the Sponsor
    First Affiliated Hospital Xi'an Jiaotong University

    4. Oversight

    Data Monitoring Committee
    No

    5. Study Description

    Brief Summary
    Acute pancreatitis is the most common and feared complication of ERCP, occurring after 1% to 30% of procedures. Since 2012, a multicenter RCT was published in NEJM, indomethacin use in high risk patients was considered a "standard" method to prevent PEP. The mechanism of indomethacin is dependent on COX-2 inhibitor. According to data, we design the project. The purpose of this study is to determine whether COX-2 inhibitor is effective on control of Post-ERCP pancreatitis.
    Detailed Description
    This prospective, randomised controlled trial was done in 8 tertiary referral hospitals in China. Patients (aged 18-90 years) with native papilla planned for diagnostic or therapeutic ERCP were eligible for enrolment in the study. Exclusion criteria included contraindications to ERCP, known pancreatic head mass, previous biliary sphincterotomy without planned contrast injection into the pancreatic duct, acute pancreatitis within 3 days, ERCP for biliary stent removal or exchange without anticipated pancreatogram, known active cardiovascular or cerebrovascular disease, unwilling or inability to provide consent, and pregnant or breastfeeding women. Indications or contra- indications for ERCP were determined by endoscopists or anaesthesiologists before ERCP; these included risks to patient health or life judged to outweigh the potential benefit of ERCP, known or suspected perforated viscus, and haemodynamic instability. The risk stratification of the patients was defined based on criteria used in the study by Elmunzer and colleages. Patients were considered high risk for post-ERCP pancreatitis if they met at least one of the major criteria or two or more of the minor criteria. The risk status of the patients was determined immediately after the procedure by one investigator at each site who was masked to group allocation. Randomisation and masking The study coordinator did the block randomization (ten in each block). The randomization list was computer generated, and stratified according to individual centers. Patients were assigned randomly in a 1:1 ratio, before receiving ERCP, to either the universal pre- procedural group or the risk-stratified post-procedural group. Cox-2 inhibitor or Indometacin was administered in the procedure room before or after ERCP by one investigator in each site who did not participate in data collection and analysis. Endoscopists and assistances who participated in ERCP procedures were masked to group allocation. Investigators who collected demographic or procedure-related data or participated in the assessment of post-ERCP compli- cations were also masked to group allocation. Patients were not masked to treatment allocation. Before the start of this study, post-procedural selective indometacin in high-risk patients had been demonstrated as effective in the prevention of post-ERCP pancreatitis. Outcomes The primary outcome of the study was the frequency of post-ERCP pancreatitis. The diagnosis of post-ERCP pancreatitis was established if there was new onset of upper abdominal pain associated with an elevated serum amylase of at least three times the upper limit of normal range at 24 h after the procedure, and admission to hospital for at least 2 nights. The secondary outcome was the frequency of moderate to severe post-ERCP pancreatitis. We defined severity of pancreatitis according to the criteria reported by Cotton and colleagues. Other post-ERCP complications (including bleeding, biliary infection, perforation, and any adverse outcomes requiring hospital admission or prolonged hospital stay for further management) were monitored as described previously.24 Moderate to severe bleeding was defined as clinically significant bleeding with decrease in haemoglobin concentration of at least 3 g/L with the need for transfusion, angiographic intervention, or surgery. 23 Patients were contacted at 30 days to assess late complications (including delayed bleeding or cardiovascular or renal adverse events); this was the final follow-up. An investigator who was familiar with ERCP at each site and masked to treatment allocation recorded the procedure-related parameters including cannulation methods, numbers of cannulation attempts, and inadvertent pancreatic duct cannulation, pancrea- tography, and prophylactic placement of pancreatic duct stent. The same investigator also recorded the patient demographics, post-ERCP adverse events potentially caused by the procedure or study drug, and follow-up data. All data were subsequently entered into a web- based database and managed by independent investigators. We defined severity of post-ERCP complications according to the Cotton criteria:23 mild (pancreatitis after the procedure requiring admission or prolongation of planned admission to 2-3 days); moderate (pancreatitis after the procedure requiring hospitalisation of 4-10 days); and severe (pancreatitis after the procedure requiring hospitalisation for more than 10 days, or haemorrhagic pancreatitis, phlegmon or pseudocyst, or intervention). Detailed definitions for other adverse events are provided in the appendix.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Pancreatitis, Acute
    Keywords
    COX-2, ERCP, Pancreatitis

    7. Study Design

    Primary Purpose
    Treatment
    Study Phase
    Phase 4
    Interventional Study Model
    Parallel Assignment
    Masking
    Investigator
    Allocation
    Randomized
    Enrollment
    2700 (Anticipated)

    8. Arms, Groups, and Interventions

    Arm Title
    Cox-2
    Arm Type
    Experimental
    Arm Description
    Cox-2 inhibitor ParecoxibNa 40mg pre-ERCP injection
    Arm Title
    Indomethacin
    Arm Type
    Active Comparator
    Arm Description
    Rectal Indomethacin was administrated immediately after ERCP in high-risk patients, while average risk patients did not.
    Intervention Type
    Drug
    Intervention Name(s)
    Cox-2
    Other Intervention Name(s)
    ParecoxibNa
    Intervention Type
    Drug
    Intervention Name(s)
    Indomethacin
    Other Intervention Name(s)
    NSAID
    Primary Outcome Measure Information:
    Title
    Post-ERCP Pancreatitis
    Time Frame
    30 days
    Secondary Outcome Measure Information:
    Title
    Moderate-to-severe Pancreatitis
    Time Frame
    30 days

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    18 Years
    Maximum Age & Unit of Time
    80 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion Criteria: Patients undergoing diagnostic or therapeutic ERCP Exclusion Criteria: Unwillingness or inability to consent for the study Age < 18 years old Intrauterine pregnancy Breastfeeding mother Standard contraindications to ERCP Renal failure (Cr >1.4mg/dl=120umol/l) Acute pancreatitis within 72 hours Known pancreatic head mass Subject with prior biliary sphincterotomy now scheduled for repeat biliary therapy without anticipated pancreatogram ERCP for biliary stent removal or exchange without anticipated pancreatogram; Known active cardiovascular or cerebrovascular disease. Presence of coagulopathy before the procedure or received anticoagulation therapy within three days before the procedure;
    Central Contact Person:
    First Name & Middle Initial & Last Name or Official Title & Degree
    Zheng Wang, MD
    Phone
    0086-15902993665
    Email
    wangzheng0923@126.com
    First Name & Middle Initial & Last Name or Official Title & Degree
    Jun Lv
    Phone
    xjyfyllh@163.com
    Email
    xjyfyllh@163.com

    12. IPD Sharing Statement

    Plan to Share IPD
    Yes

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