Elsevier

Gastrointestinal Endoscopy

Volume 76, Issue 6, December 2012, Pages 1152-1159
Gastrointestinal Endoscopy

Original article
Clinical endoscopy
Nonsteroidal anti-inflammatory drugs for prevention of post-ERCP pancreatitis: a meta-analysis

https://doi.org/10.1016/j.gie.2012.08.021Get rights and content

Background

The use of nonsteroidal anti-inflammatory drugs (NSAIDs) in the prevention of post-ERCP pancreatitis (PEP) is still controversial.

Objective

We performed a meta-analysis to evaluate the efficacy and safety of NSAIDs for PEP prophylaxis.

Design

We systematically searched PubMed, EMBASE, Web of Science, and the Cochrane Library for relevant studies published updated to June 2012.

Setting

Meta-analysis.

Patients

Patients undergoing ERCP.

Interventions

NSAIDs use for the prevention of PEP.

Main Outcome Measurements

Overall incidence of PEP, incidence of moderate to severe PEP, and adverse events.

Results

Ten RCTs involving 2269 patients were included. Meta-analysis showed that NSAID use decreased the overall incidence of PEP (risk ratio [RR], 0.57; 95% CI, 0.38-0.86; P = .007). The absolute risk reduction was 5.9%. The number needed to treat was 17. Heterogeneity among the studies was substantial. However, after removing the main source of heterogeneity, the prophylactic efficacy was similar (RR, 0.53; 95% CI, 0.41-0.68; P < .001). NSAID use also decreased the incidence of moderate to severe PEP (RR 0.46; 95% CI, 0.28-0.75; P = .002). The absolute risk reduction was 3.0%. The number needed to treat was 34. No differences of the adverse events attributable to NSAIDs were observed.

Limitations

Inclusion of low-quality studies, different type and route of administration of the NSAIDs, study heterogeneity, inconsistent use of pancreatic stenting.

Conclusions

Prophylactic use of NSAIDs reduces the incidence and severity of PEP.

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.

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    DISCLOSURE: The authors disclosed no financial relationships relevant to this publication.

    See CME section; p. 1210.

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