Abstract
BackgroundAcute pancreatitis is a severe complication of endoscopic retrograde cholangiopancreatography (ERCP). Previous meta-analyses have shown that indomethacin effectively prevents this complication; however, the data are limited. We performed a systematic review and meta-analysis to clarify the applications for rectal indomethacin.MethodsA systematic search was performed in June 2016. Human prospective, randomized, placebo-controlled trials that compared rectally administered indomethacin with a placebo for the prevention of post-ERCP pancreatitis (PEP) were included. A meta-analysis was performed using a random-effects model to assess the outcomes (PEP) using Review Manager 5.0.ResultsSeven randomized controlled trials met the inclusion criteria (n = 3013). The overall incidence of PEP was significantly lower after prophylactic administration of rectal indomethacin than after administration of the placebo (RR, 0.58, 95% CI, 0.40–0.83; P = 0.004). A subgroup analysis was performed for rectal indomethacin administration compared to a placebo in high-risk patients (RR, 0.46; 95% CI, 0.32–0.65; P < 0.00001) and average-risk patients (RR, 0.75; 95% CI, 0.46–1.22; P = 0.25) and for administration before ERCP (RR, 0.56; 95% CI, 0.39–0.79; P = 0.001) and after the procedure (RR, 0.61; 95% CI, 0.26–1.44; P = 0.26).ConclusionsThis meta-analysis indicated that prophylactic rectal indomethacin is not suitable for all patients undergoing ERCP but it is safe and effective to prevent PEP in high-risk patients. In addition, rectal indomethacin administration before ERCP is superior to its administration after ERCP for the prevention of PEP.
Highlights
Acute pancreatitis is a severe complication of endoscopic retrograde cholangiopancreatography (ERCP)
A total of 7 randomized controlled trials (RCTs) with 3013 participants were included in the meta-analysis [10, 14,15,16,17,18,19]
The Mantel-Haenszel pooled Relative Risk (RR) for post-ERCP pancreatitis (PEP) after prophylactic administration of rectal indomethacin compared to the placebo was 0.58, corresponding to an absolute risk reduction of 4.8 percentage points and a relative risk reduction of 43%
Summary
Acute pancreatitis is a severe complication of endoscopic retrograde cholangiopancreatography (ERCP). Acute pancreatitis is the most common complication after post-endoscopic retrograde cholangiopancreatography (ERCP). The incidence rate of post-ERCP pancreatitis (PEP) ranges between 1.6 and 15.7%, with an overall average of 3.5% [1]. While most cases of PEP are mild, 10-20% of patients may develop severe acute pancreatitis with adverse outcomes and many intractable complications. The detailed pathogenesis of PEP remains unknown, and no specific or effective treatment for pancreatitis has been developed. Numerous factors have been found to be correlated with the development of PEP, including patient-related factors, such as an age of less than 50 years, female sex, pancreas divisum, sphincter of Oddi dysfunction (SOD), a history of recurrent pancreatitis (≥2 episodes) or history of PEP, and
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