Indometacin With or Without Aggressive Intravenous Hydration to Prevent Pancreatitis After Pancreatic Extracorporeal Shock Wave Lithotripsy

Exclusion Criteria

• •Patients readmitted to the hospital for ESWL during the study period
• •contraindications to ESWL
• •Signs of congestive heart failure, such as pitting edema or a New York Heart Association classification greater than class I heart failure. For patients ≥ 70 years old, brain natriuretic peptide (BNP) and cardiac ultrasound would be performed before ESWL. Patients with BNP\>100pg/ml or Ejection Fraction value\<50% should be excluded
• •Respiratory insufficiency (pO2 \< 60 mmHg or saturation \< 90% despite FiO2 of 30% or requiring mechanical ventilation). For patients ≥ 70 years old, pulmonary function tests would be performed before ESWL. Patients with Forced Expiratory Volume in the first second (FEV1) \<70% are excluded
• •Patients receiving more than 1.5 mL/kg/h or 3 L/24 h of intravenous fluids in the 24 h before ESWL
• •Hypotension (systolic blood pressure \<90 mmHg or mean arterial pressure \<70 mmHg)
• •Hypo- or hypernatremia (serum Na+ levels \< 130 or \> 150 mmol/L)
• •Severe liver disease (cirrhosis with ascites, liver abscess)
• •receiving NSAIDs within 7 days
• •Contraindications for rectal use of NSAIDs (renal dysfunction with serum creatinine \>120 μmol/L, allergy, active gastrointestinal bleeding, ulcer disease, and NSAID use for other indications \[other than cardioprotective aspirin\])
• •presence of coagulopathy or received anticoagulation therapy within 3 days
• •acute pancreatitis within 3 days
• •known active cardiovascular or cerebrovascular disease
• •pregnant or breastfeeding women
• •without a rectum (ie, status post-total proctocolectomy)