The role of nonsteroidal anti-inflammatory drugs in the prevention of post-ERCP pancreatitis:a meta analysis

Abstract

Objective To evaluate the efficacy of in the prevention and alleviation of postERCP pancreatitis and to provide theoretical basis for clinical practice and enhance the improvement of clinical studies on post-ERCP pancreatitis medication.Methods We performed extensive literature search from computerized databases MEDLINE(Jan.1966-Jan.2011),EMBASE(Jan.1966-Jan.2011) and the Cochrane Central Register of Controlled Trials(Issue 1,2011) using the key words endoscopic retrograde cholangiopancreatography or ERCP, NSAIDs or nonsteroidal anti-inflammatory drugs, pancreatitis,indomethacin and diclofenac.The following primary outcomes were assessed:(1) Incidence of PEP;(2)Mortality of PEP;(3) Adverse events.Pooled odds ratio and 95％ confidence interval were computed using Revman version 4.3.2 from Cochrane.org web.Results Five multinational RCTs were included in our metaanalysis.There were in total 1119 patients involved in this meta-analysis,including 561 individuals in the treatment group and 558 participants in the placebo group.Among the patients in the treatment group,265 were treated by diclofenac and 296 were treated by indomethacin.The placebo group had same duration and dose of treatment with the treatment group.The prevalence of post-ERCP pancreatitis was significantly lower in the treatment group than in the placebo group(6.60％ vs.13.26％ ; OR =0.45 ; P ＜ 0.001).The pooled odds ratio for with mild PEP was 0.48(95 ％ CI:0.31-0.76 ; P =0.002) and the pooled odds ratio for with moderate to severe PEP was 0.44(P =0.08).Conclusion Based on the findings from the present systematic review of 5 RCTs,NSAIDs are effective and well tolerated in the prevention of PEP. Key words: Post-endoscopic retrograde cholangiopancreatography; Pancreatitis; Nonsteroidal antiinflammatory drugs; Randomized controlled trial; Meta-analysis