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A meta-analysis of rectal NSAIDs in the prevention of post-ERCP pancreatitis.
Gut. 2008 Sep; 57(9):1262-7.Gut

Abstract

BACKGROUND

Several pharmacological agents for the prevention of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) have been studied. Clinical trials evaluating the protective effect of non-steroidal anti-inflammatory drugs (NSAIDs) have yielded inconclusive results.

AIM

To perform a meta-analysis of studies evaluating the effect of prophylactic rectal NSAIDs on PEP.

METHODS

By searching Medline, Embase, meeting abstracts and bibliographies, two independent reviewers systematically identified prospective randomised controlled trials (RCTs) examining the effect of rectally administered prophylactic NSAIDs on the incidence of PEP pancreatitis. A meta-analysis of these clinical trials was performed.

RESULTS

Four RCTs, enrolling a total of 912 patients, have been published. Meta-analysis of these studies demonstrates a pooled relative risk for PEP after prophylactic administration of NSAIDs of 0.36 (95% CI 0.22 to 0.60); patients who received NSAIDs in the periprocedural period were 64% less likely to develop pancreatitis and 90% less likely to develop moderate to severe pancreatitis. The pooled number needed to treat with NSAIDs to prevent one episode of pancreatitis is 15 patients. No adverse events attributable to the use of NSAIDs were reported in any of the clinical trials.

CONCLUSION

In this meta-analysis, prophylactic NSAIDs were effective in preventing PEP. Widespread prophylactic administration of these agents may significantly reduce the incidence of PEP, resulting in major clinical and economic benefit. Given current scepticism regarding the efficacy of any prophylactic medication for ERCP, additional multicentre studies are needed for confirmation prior to widespread adoption of this strategy.

Authors+Show Affiliations

Division of Gastroenterology, Department of Medicine, University of Michigan Medical Center, Ann Arbor, Michigan 48109, USA. badihe@umich.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Review

Language

eng

PubMed ID

18375470

Citation

Elmunzer, B J., et al. "A Meta-analysis of Rectal NSAIDs in the Prevention of post-ERCP Pancreatitis." Gut, vol. 57, no. 9, 2008, pp. 1262-7.
Elmunzer BJ, Waljee AK, Elta GH, et al. A meta-analysis of rectal NSAIDs in the prevention of post-ERCP pancreatitis. Gut. 2008;57(9):1262-7.
Elmunzer, B. J., Waljee, A. K., Elta, G. H., Taylor, J. R., Fehmi, S. M., & Higgins, P. D. (2008). A meta-analysis of rectal NSAIDs in the prevention of post-ERCP pancreatitis. Gut, 57(9), 1262-7. https://doi.org/10.1136/gut.2007.140756
Elmunzer BJ, et al. A Meta-analysis of Rectal NSAIDs in the Prevention of post-ERCP Pancreatitis. Gut. 2008;57(9):1262-7. PubMed PMID: 18375470.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A meta-analysis of rectal NSAIDs in the prevention of post-ERCP pancreatitis. AU - Elmunzer,B J, AU - Waljee,A K, AU - Elta,G H, AU - Taylor,J R, AU - Fehmi,S M A, AU - Higgins,P D R, Y1 - 2008/03/28/ PY - 2008/4/1/pubmed PY - 2008/9/5/medline PY - 2008/4/1/entrez SP - 1262 EP - 7 JF - Gut JO - Gut VL - 57 IS - 9 N2 - BACKGROUND: Several pharmacological agents for the prevention of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) have been studied. Clinical trials evaluating the protective effect of non-steroidal anti-inflammatory drugs (NSAIDs) have yielded inconclusive results. AIM: To perform a meta-analysis of studies evaluating the effect of prophylactic rectal NSAIDs on PEP. METHODS: By searching Medline, Embase, meeting abstracts and bibliographies, two independent reviewers systematically identified prospective randomised controlled trials (RCTs) examining the effect of rectally administered prophylactic NSAIDs on the incidence of PEP pancreatitis. A meta-analysis of these clinical trials was performed. RESULTS: Four RCTs, enrolling a total of 912 patients, have been published. Meta-analysis of these studies demonstrates a pooled relative risk for PEP after prophylactic administration of NSAIDs of 0.36 (95% CI 0.22 to 0.60); patients who received NSAIDs in the periprocedural period were 64% less likely to develop pancreatitis and 90% less likely to develop moderate to severe pancreatitis. The pooled number needed to treat with NSAIDs to prevent one episode of pancreatitis is 15 patients. No adverse events attributable to the use of NSAIDs were reported in any of the clinical trials. CONCLUSION: In this meta-analysis, prophylactic NSAIDs were effective in preventing PEP. Widespread prophylactic administration of these agents may significantly reduce the incidence of PEP, resulting in major clinical and economic benefit. Given current scepticism regarding the efficacy of any prophylactic medication for ERCP, additional multicentre studies are needed for confirmation prior to widespread adoption of this strategy. SN - 1468-3288 UR - https://www.unboundmedicine.com/medline/citation/18375470/A_meta_analysis_of_rectal_NSAIDs_in_the_prevention_of_post_ERCP_pancreatitis_ L2 - http://gut.bmj.com/cgi/pmidlookup?view=long&pmid=18375470 DB - PRIME DP - Unbound Medicine ER -