Evidence map›Paper›PMID 39922728›Full record

ArticlePancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.]2025

Why is the rectal route for NSAIDS favorable for preventing post-ERCP pancreatitis?

Gayathri Swaminathan, Yu-Chu Lin, Jianbo Ni, Asna Khalid, Cheng-Yu Tsai, Ying Ding, Na Bo, Judy-April Murayi, Thottala Jayaraman, Ronald Poropatich and 8 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.], 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Trial
  3. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

18 authors.

Gayathri SwaminathanDivision of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Stanford University, School of Medicine, Stanford, CA, USA.
Yu-Chu LinDivision of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Stanford University, School of Medicine, Stanford, CA, USA.
Jianbo NiDivision of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Stanford University, School of Medicine, Stanford, CA, USA; Department of Gastroenterology and Shanghai Key Laboratory of Pancreatic Disease, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Asna KhalidDivision of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Stanford University, School of Medicine, Stanford, CA, USA.
Cheng-Yu TsaiDivision of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Stanford University, School of Medicine, Stanford, CA, USA.
Ying DingDepartment of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA.
Na BoDepartment of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA.
Judy-April MurayiDivision of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA.
Thottala JayaramanDepartment of Oral and Craniofacial Sciences, School of Dental Medicine, McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
Ronald PoropatichUniversity of Pittsburgh, School of Medicine, Pittsburgh, PA, USA.
Rita BottinoImagine Islet Center, Imagine Pharma, 1401 Forbes Avenue, Pittsburgh, PA, USA.
Georgios I PapachristouThe Ohio State University Wexner Medical Center, Columbus, OH, USA.
Sunil G ShethBeth Israel Deaconess Medical Center, Boston, MA, USA.
Li WenInstitute of Clinical Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China.
Monique T BarakatDivision of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Stanford University, School of Medicine, Stanford, CA, USA; Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
Adam R FrymoyerDivision of Neonatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.
Mang YuDivision of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Stanford University, School of Medicine, Stanford, CA, USA. Electronic address: myu2045@gmail.com.
Sohail Z HusainDivision of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Stanford University, School of Medicine, Stanford, CA, USA. Electronic address: sohail.husain@stanford.edu.

Funding

Calcineurin in pancreatitisR01DK093491 · NIDDK · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · PI HUSAIN, SOHAIL Z · 2011 to 2020
$3.7M
NIDDK NIH HHS R01 DK093491
6 · The paper itself

Abstract

objectiveAcute pancreatitis is a frequent, burdensome adverse event of endoscopic retrograde cholangiography (ERCP). Rectal nonsteroidal anti-inflammatory drugs (NSAIDs) have reduced post-ERCP pancreatitis (PEP) risk by about 50 % and show greater efficacy over parenteral or oral administration, although the mechanism for its superiority remains unclear. To probe this question, we investigated in a preclinical model, the pharmacokinetics in the blood, pancreas and other tissues of the NSAID diclofenac given via the rectal, intravenous, or intragastric routes.

methodsThe data on diclofenac was extracted from a larger study that examined a combination of diclofenac and tacrolimus. 20.8 mg diclofenac/kg body weight, which is the mouse equivalent dosing used in clinical practice for PEP prophylaxis, was administered to C57BL/6J mice via the rectal, intravenous and intragastric (oral) routes. Cross-collection of blood and tissues was done at various timepoints after administration for the evaluation of drug levels and pharmacokinetic parameters.

resultsRectal diclofenac demonstrated favorable blood pharmacokinetics and systemic bioavailability as well as sustained pancreas penetration. The total pancreas exposure to diclofenac over 24 h following rectal dosing was not significantly different as compared to intravenous and oral dosing.

conclusionOur findings suggest that the efficacy of rectal diclofenac in PEP prevention relates more to its higher and consistent systemic exposure than its absolute pancreas levels. The implications are that the rectal route provides both systemic and pancreas exposure for the full duration of PEP vulnerability.

Indexed as

Anti-Inflammatory Agents, Non-SteroidalCholangiopancreatography, Endoscopic RetrogradeDiclofenacPancreatitisAdministration, RectalAnimalsMaleMiceMice, Inbred C57BLPancreasAnti-Inflammatory Agents, Non-SteroidalDiclofenacDiclofenacPharmacokineticsPost-ERCP pancreatitisRectal

Identifiers

PMID39922728
PMCPMC12213200

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.