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Glyceryl trinitrate for prevention of post-ERCP pancreatitis and improve the rate of cannulation: a meta-analysis of prospective, randomized, controlled trials.
PLoS One 2013; 8(10):e75645Plos

Abstract

BACKGROUND

Acute pancreatitis is the most common complication of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP). Several clinical trials used glyceryl trinitrate (GTN) to prevent the incidence of post-ERCP pancreatitis (PEP). However, the results were still controversial.

OBJECTIVE

To conduct a meta-analysis of published, full-length, randomized controlled trials evaluating the effect of prophylactic GTN on the prevention of PEP, improve the rate of cannulation and the prevention of hyperamylasemia.

METHODS

Literature searches were conducted using PubMed, EMBASE, The Cochrane Library and Web of Knowledge databases, using keywords "post-ERCP" and "pancreatitis" and limited in randomized controlled trials.

RESULTS

Twelve RCTs involving 2649 patients were included. Eleven RCTs compared GTN with placebo for PEP prevention. Meta-analysis showed the overall incidence of PEP was significantly reduced by GTN treatment (RR 0.67; 95% CI, 0.52-0.87). Nevertheless, GTN administration did not decrease the incidence of moderate to severe PEP (RR 0.70; 95% CI, 0.42-1.15). Subgroup analyses revealed that GTN administered by sublingual was more effective than transdermal and topical in reducing the incidence of PEP. Besides, the prophylactic effect of GTN was far more obvious in the group of high PEP incidence than in the group of low PEP incidence. Additionally, the incidence of hyperamylasemia was significantly reduced by GTN treatment (RR 0.69; 95% CI, 0.54-0.90). No differences of the successful cannulation rate of bile ducts (RR 1.03; 95% CI, 0.99-1.06) attributable to GTN were observed.

CONCLUSION

Prophylactic use of GTN reduced the overall incidence of PEP and hyperamylasemia. However, GTN was not helpful for the severity of PEP and the rate of cannulation.

Authors+Show Affiliations

Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24098392

Citation

Ding, Jiexia, et al. "Glyceryl Trinitrate for Prevention of post-ERCP Pancreatitis and Improve the Rate of Cannulation: a Meta-analysis of Prospective, Randomized, Controlled Trials." PloS One, vol. 8, no. 10, 2013, pp. e75645.
Ding J, Jin X, Pan Y, et al. Glyceryl trinitrate for prevention of post-ERCP pancreatitis and improve the rate of cannulation: a meta-analysis of prospective, randomized, controlled trials. PLoS ONE. 2013;8(10):e75645.
Ding, J., Jin, X., Pan, Y., Liu, S., & Li, Y. (2013). Glyceryl trinitrate for prevention of post-ERCP pancreatitis and improve the rate of cannulation: a meta-analysis of prospective, randomized, controlled trials. PloS One, 8(10), pp. e75645. doi:10.1371/journal.pone.0075645.
Ding J, et al. Glyceryl Trinitrate for Prevention of post-ERCP Pancreatitis and Improve the Rate of Cannulation: a Meta-analysis of Prospective, Randomized, Controlled Trials. PLoS ONE. 2013;8(10):e75645. PubMed PMID: 24098392.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Glyceryl trinitrate for prevention of post-ERCP pancreatitis and improve the rate of cannulation: a meta-analysis of prospective, randomized, controlled trials. AU - Ding,Jiexia, AU - Jin,Xi, AU - Pan,Yue, AU - Liu,Shan, AU - Li,Youming, Y1 - 2013/10/01/ PY - 2013/06/09/received PY - 2013/08/15/accepted PY - 2013/10/8/entrez PY - 2013/10/8/pubmed PY - 2014/6/24/medline SP - e75645 EP - e75645 JF - PloS one JO - PLoS ONE VL - 8 IS - 10 N2 - BACKGROUND: Acute pancreatitis is the most common complication of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP). Several clinical trials used glyceryl trinitrate (GTN) to prevent the incidence of post-ERCP pancreatitis (PEP). However, the results were still controversial. OBJECTIVE: To conduct a meta-analysis of published, full-length, randomized controlled trials evaluating the effect of prophylactic GTN on the prevention of PEP, improve the rate of cannulation and the prevention of hyperamylasemia. METHODS: Literature searches were conducted using PubMed, EMBASE, The Cochrane Library and Web of Knowledge databases, using keywords "post-ERCP" and "pancreatitis" and limited in randomized controlled trials. RESULTS: Twelve RCTs involving 2649 patients were included. Eleven RCTs compared GTN with placebo for PEP prevention. Meta-analysis showed the overall incidence of PEP was significantly reduced by GTN treatment (RR 0.67; 95% CI, 0.52-0.87). Nevertheless, GTN administration did not decrease the incidence of moderate to severe PEP (RR 0.70; 95% CI, 0.42-1.15). Subgroup analyses revealed that GTN administered by sublingual was more effective than transdermal and topical in reducing the incidence of PEP. Besides, the prophylactic effect of GTN was far more obvious in the group of high PEP incidence than in the group of low PEP incidence. Additionally, the incidence of hyperamylasemia was significantly reduced by GTN treatment (RR 0.69; 95% CI, 0.54-0.90). No differences of the successful cannulation rate of bile ducts (RR 1.03; 95% CI, 0.99-1.06) attributable to GTN were observed. CONCLUSION: Prophylactic use of GTN reduced the overall incidence of PEP and hyperamylasemia. However, GTN was not helpful for the severity of PEP and the rate of cannulation. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/24098392/Glyceryl_trinitrate_for_prevention_of_post_ERCP_pancreatitis_and_improve_the_rate_of_cannulation:_a_meta_analysis_of_prospective_randomized_controlled_trials_ L2 - http://dx.plos.org/10.1371/journal.pone.0075645 DB - PRIME DP - Unbound Medicine ER -