Original articleClinical endoscopyNonsteroidal anti-inflammatory drugs for prevention of post-ERCP pancreatitis: a meta-analysis
Section snippets
Identification and selection of studies
Relevant trials were identified by searching electronic databases including PubMed, EMBASE, Web of Science, and the Cochrane Library updated to June 2012. The search terms included “nonsteroidal anti-inflammatory drugs,” “diclofenac,” “indomethacin,” “aspirin,” “ibuprofen,” “naproxen,” “ketorolac,” “etodolac,” “sulindac,” “cyclooxygenase 2 inhibitors,” “celecoxib,” “rofecoxib,” “valdecoxib,” “pancreatitis,” and “ERCP.” Reference lists from the trials, review articles, and previously published
Selection and features of studies
The search identified 13 relevant prospective, RCTs (Fig. 1). Two reports came from the same study center,21, 22 and we only included data from the publication with the largest population.22 One study in the form of abstract was excluded because it had been published as a full article.23 Another study was excluded because the somatostatin was also used in the NSAIDs group.24 In the end, a total of 10 RCTs were included.8, 9, 10, 11, 12, 13, 22, 25, 26, 27 Basic characteristics of the included
Discussion
Meta-analysis of the 10 included RCTs demonstrates that the RR of PEP developing after prophylactic NSAID use is 0.57 (95% CI, 0.38-0.86). In other words, patients who received NSAIDs in the periprocedural period were 43% less likely to have pancreatitis. The NNT to prevent 1 episode of pancreatitis is 17. NSAID-treated patients also had a 54% reduction of the development of moderate to severe PEP. The NNT to prevent 1 episode of moderate to severe pancreatitis is 34. Of note, no differences in
Conclusions
This meta-analysis shows that the prophylactic use of NSAIDs is a safe and effective intervention for preventing PEP.
References (37)
- et al.
Prevention of post-ERCP pancreatitis: a comprehensive review
Gastrointest Endosc
(2004) - et al.
Efficacy of diclofenac in the prevention of post-ERCP pancreatitis in predominantly high-risk patients: a randomized double-blind prospective trial
Gastrointest Endosc
(2007) - et al.
A prospective, multicenter, randomized, double blinded controlled study to determine whether a single dose of intraduodenal indomethacin can decrease the incidence and severity of post-ERCP pancreatitis
Gastrointest Endosc
(2010) - et al.
Assessing the quality of reports of randomized clinical trials: is blinding necessary?
Control Clin Trials
(1996) - et al.
Meta-analysis in clinical trials
Control Clin Trials
(1986) - et al.
Diclofenac reduces the incidence of acute pancreatitis after endoscopic retrograde cholangiopancreatography
Gastroenterology
(2003) - et al.
Endoscopic sphincterotomy complications and their management: an attempt at consensus
Gastrointest Endosc
(1991) - et al.
Pancreatic stents for prophylaxis against post-ERCP pancreatitis: a meta-analysis and systematic review
Gastrointest Endosc
(2011) - et al.
Pancreatic-stent placement for prevention of post-ERCP pancreatitis: a cost-effectiveness analysis
Gastrointest Endosc
(2007) - et al.
Does quality of reports of randomised trials affect estimates of intervention efficacy reported in meta-analyses?
Lancet
(1998)
Clinical pharmacokinetics of diclofenacTherapeutic insights and pitfalls
Clin Pharmacokinet
Inflammatory mediators and cytokines–new aspects of the pathophysiology and assessment of severity of acute pancreatitis?
Hepatogastroenterology
Inhibition of serum phospholipase-A2 in acute pancreatitis by pharmacological agents in vitro
Scand J Clin Lab Invest
Acute hemorrhagic pancreatitis in mice: improved survival after indomethacin administration
Digestion
A meta-analysis of rectal NSAIDs in the prevention of post-ERCP pancreatitis
Gut
Rectal administration of NSAIDs in the prevention of post-ERCP pancreatitis: a complementary meta-analysis
Gut
Efficacy of intramuscular diclofenac and fluid replacement in prevention of post-ERCP pancreatitis
World J Gastroenterol
A randomized controlled trial of valdecoxib and glyceryl trinitrate for the prevention of post-ERCP pancreatitis
J Clin Gastroenterol
Cited by (0)
DISCLOSURE: The authors disclosed no financial relationships relevant to this publication.
See CME section; p. 1210.