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Nonsteroidal anti-inflammatory drugs for prevention of post-ERCP pancreatitis: a meta-analysis.
Gastrointest Endosc. 2012 Dec; 76(6):1152-9.GE

Abstract

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.

Authors+Show Affiliations

Department of Gastroenterology, Drum Tower Hospital Affiliated with Medical School of Nanjing University, Nanjing, China.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis

Language

eng

PubMed ID

23164513

Citation

Ding, Xiwei, et al. "Nonsteroidal Anti-inflammatory Drugs for Prevention of post-ERCP Pancreatitis: a Meta-analysis." Gastrointestinal Endoscopy, vol. 76, no. 6, 2012, pp. 1152-9.
Ding X, Chen M, Huang S, et al. Nonsteroidal anti-inflammatory drugs for prevention of post-ERCP pancreatitis: a meta-analysis. Gastrointest Endosc. 2012;76(6):1152-9.
Ding, X., Chen, M., Huang, S., Zhang, S., & Zou, X. (2012). Nonsteroidal anti-inflammatory drugs for prevention of post-ERCP pancreatitis: a meta-analysis. Gastrointestinal Endoscopy, 76(6), 1152-9. https://doi.org/10.1016/j.gie.2012.08.021
Ding X, et al. Nonsteroidal Anti-inflammatory Drugs for Prevention of post-ERCP Pancreatitis: a Meta-analysis. Gastrointest Endosc. 2012;76(6):1152-9. PubMed PMID: 23164513.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Nonsteroidal anti-inflammatory drugs for prevention of post-ERCP pancreatitis: a meta-analysis. AU - Ding,Xiwei, AU - Chen,Min, AU - Huang,Shuling, AU - Zhang,Song, AU - Zou,Xiaoping, PY - 2012/06/02/received PY - 2012/08/18/accepted PY - 2012/11/21/entrez PY - 2012/11/21/pubmed PY - 2013/4/30/medline SP - 1152 EP - 9 JF - Gastrointestinal endoscopy JO - Gastrointest. Endosc. VL - 76 IS - 6 N2 - 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. SN - 1097-6779 UR - https://www.unboundmedicine.com/medline/citation/23164513/Nonsteroidal_anti_inflammatory_drugs_for_prevention_of_post_ERCP_pancreatitis:_a_meta_analysis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016-5107(12)02641-7 DB - PRIME DP - Unbound Medicine ER -