Abstract
Rectal nonsteroidal anti-inflammatory drugs (NSAIDs) are not commonly used clinically for preventing post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. To evaluate the efficacy and safety of NSAIDs for post-ERCP prophylaxis, we systematically reviewed sixteen randomized controlled trials (involving 6458 patients) that compared rectal NSAIDs with placebo or no treatment for post-ERCP pancreatitis prophylaxis updated to August 2016. GRADE framework was used to assess the quality of evidence. There was “high quality” evidence that rectal NSAIDs were associated with significant reduction in the risk of overall post-ERCP pancreatitis (RR, 0.55; 95% CI, 0.42–0.71). Subgroup analyses demonstrated that diclofenac (RR, 0.41; 95% CI, 0.19–0.90) was probably superior to indomethacin (RR, 0.58; 95% CI, 0.45–0.75), post-ERCP administration (RR, 0.46; 95% CI, 0.24–0.89) was probably superior to pre-ERCP (RR, 0.53; 95% CI, 0.42–0.67), and that mixed-risk population received more benefits (RR, 0.54; 95% CI, 0.33–0.88) than average-risk population (RR, 0.60; 95% CI, 0.41–0.88), but less than high-risk population (RR, 0.41; 95% CI, 0.19–0.91). Moreover, “high quality” evidence showed that rectal NSAIDs were safe when given as a standard dose (RR = 0.80; 95% CI, 0.47–1.36). In conclusion, this meta-analysis revealed that rectal NSAIDs are effective and safe in the prevention of post-ERCP pancreatitis in populations with all levels of risk.
Highlights
Acute pancreatitis is the most common complication of endoscopic retrograde cholangiopancreatography (ERCP)
Nine new RCTs17–20,22,24,26–28 have been conducted since the last meta-analyses of rectal nonsteroidal anti-inflammatory drugs (NSAIDs) for post-ERCP pancreatitis prophylaxis and included an additional 4592 patients
To provide clinical practice guidance and a framework for future research in this important area, we conducted a meta-analysis with systematic review of randomized controlled trial (RCT) currently available and evaluated the efficacy and safety of rectal NSAIDs for the prevention of post-ERCP pancreatitis
Summary
Acute pancreatitis is the most common complication of endoscopic retrograde cholangiopancreatography (ERCP). The reported frequency of post-ERCP pancreatitis varies between 1% and 13.3% in the unselected patients[1,2,3], it may reach 25–39% in certain high risk patients[4]. Because of this, it accounts for considerable morbidity, prolonged hospitalization, increasing healthcare expenditure, severe complications and occasional death[5,6,7]. Many agents are explored extensively for pharmacological potential against post-ERCP pancreatitis, such as somatostatin[8], gabexate[9], ulinastain[10], nonsteroidal anti-inflammatory drugs (NSAIDs)[11,12] and octreotide[13]. To provide clinical practice guidance and a framework for future research in this important area, we conducted a meta-analysis with systematic review of RCTs currently available and evaluated the efficacy and safety of rectal NSAIDs for the prevention of post-ERCP pancreatitis
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