Opinion Review
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 28, 2024; 30(8): 811-816
Published online Feb 28, 2024. doi: 10.3748/wjg.v30.i8.811
Nonsteroidal anti-inflammatory drugs before endoscopic ultrasound guided tissue acquisition to reduce the incidence of post procedural pancreatitis
Mike de Jong, Foke van Delft, Christine Roozen, Erwin-Jan van Geenen, Tanya Bisseling, Peter Siersema, Marco Bruno
Mike de Jong, Foke van Delft, Christine Roozen, Erwin-Jan van Geenen, Tanya Bisseling, Peter Siersema, Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen 6525 GA, Netherlands
Peter Siersema, Marco Bruno, Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam 3015 GD, Netherlands
Author contributions: de Jong M drafted the manuscript; van Delft F, Roozen C, van Geenen EJ, Bisseling T, Siersema P, and Bruno M edited the manuscript to the final version.
Conflict-of-interest statement: All the authors declare that they have no conflicts of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mike de Jong, MD, MSc, Research Fellow, Department of Gastroenterology and Hepatology, Radboud University Medical Center, 10 Geert Grooteplein Zuid, Nijmegen 6525 GA, Netherlands. mike.dejong@radboudumc.nl
Received: November 24, 2023
Peer-review started: November 24, 2023
First decision: December 15, 2023
Revised: December 22, 2023
Accepted: January 22, 2024
Article in press: January 22, 2024
Published online: February 28, 2024

Endoscopic ultrasound (EUS) with fine needle aspiration or fine needle biopsy is the gold standard for sampling tissue to diagnose pancreatic cancer and autoimmune pancreatitis or to analyze cyst fluid. The most common reported adverse event of fine needle aspiration and/or fine needle biopsy is acute pancreatitis, which is likely induced by the same pathophysiological mechanisms as after endoscopic retrograde cholangiopancreatography (ERCP). According to the current European Society of Gastrointestinal Endoscopy guideline, nonsteroidal anti-inflammatory drugs are administered prior to ERCP as a scientifically proven treatment to reduce post-ERCP pancreatitis incidence rate. A single suppository of diclofenac or indomethacin prior to EUS guided tissue acquisition (TA) is harmless in healthy adults. Since it is associated with low costs and, most important, may prevent a dreadsome complication, we strongly recommend the administration of 100 mg diclofenac rectally prior to EUS-TA. We will explain this recommendation in more detail in this review as well as the risk and pathophysiology of post-EUS TA pancreatitis.

Keywords: Pancreatitis, Endoscopic ultrasound, Tissue acquisition, Nonsteroidal anti-inflammatory drugs, Pancreatic cancer

Core Tip: Post-endoscopic ultrasound (EUS) pancreatitis has an incidence of 1%-2%. Literature on the effectiveness of diclofenac in preventing a post-EUS-tissue acquisition (TA) pancreatitis is scarce. Based on the pathophysiological mechanism, which is nearly the same in both post-endoscopic retrograde cholangiopancreatography and post-EUS pancreatitis, diclofenac could be effective as prophylaxis of post-EUS-TA pancreatitis. There are several arguments in favor of administration, such as the cost-effective prevention of post-EUS-TA pancreatitis, which could have potentially disastrous consequences. A single suppository of diclofenac has limited side effects. In conclusion, administration of diclofenac prior to EUS-TA procedure should be strongly advised to prevent post-EUS-TA pancreatitis.