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The effect of indomethacin in the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis: a meta-analysis.
Pancreas 2014; 43(3):338-42P

Abstract

OBJECTIVES

Acute pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP) is a severe complication with substantial morbidity and mortality. Indomethacin has been identified to prevent this complication; however, the results using indomethacin have varied. Therefore, we performed a meta-analysis on the efficacy of rectally administered indomethacin in the prevention of post-ERCP pancreatitis (PEP).

METHODS

A systematic search was performed in November 2012. Randomized, placebo-controlled trials (randomized controlled trials) in adult patients that compared rectally administered indomethacin versus placebo in prevention of PEP were included. Meta-analysis was performed using a fixed-effects model to assess the primary outcome (PEP) and secondary outcomes (mild or moderate to severe PEP) using Review Manager 5.1.

RESULTS

Four randomized controlled trials met the inclusion criteria (n = 1422). The use of indomethacin near the time of ERCP demonstrated a statistically significant decrease in PEP (odds ratio [OR], 0.49; 95% confidence interval [CI], 0.34-0.71; P < 0.01), mild PEP (OR, 0.52; 95% CI, 0.32-0.86; P = 0.01), and moderate to severe PEP (OR, 0.45; 95% CI, 0.24-0.83; P = 0.01) as compared with placebo. The number needed to treat with indomethacin to prevent 1 episode of pancreatitis is 17 patients.

CONCLUSIONS

Rectal indomethacin significantly reduced the incidence of PEP. We recommend using indomethacin before or just after the procedure in patients undergoing ERCP.

Authors+Show Affiliations

From the Departments of *Internal Medicine and †Anatomical Pathology, University of Missouri School of Medicine, Columbia, MO.

Pub Type(s)

Journal Article
Meta-Analysis

Language

eng

PubMed ID

24622061

Citation

Ahmad, Dina, et al. "The Effect of Indomethacin in the Prevention of Post-endoscopic Retrograde Cholangiopancreatography Pancreatitis: a Meta-analysis." Pancreas, vol. 43, no. 3, 2014, pp. 338-42.
Ahmad D, Lopez KT, Esmadi MA, et al. The effect of indomethacin in the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis: a meta-analysis. Pancreas. 2014;43(3):338-42.
Ahmad, D., Lopez, K. T., Esmadi, M. A., Oroszi, G., Matteson-Kome, M. L., Choudhary, A., & Bechtold, M. L. (2014). The effect of indomethacin in the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis: a meta-analysis. Pancreas, 43(3), pp. 338-42. doi:10.1097/MPA.0000000000000086.
Ahmad D, et al. The Effect of Indomethacin in the Prevention of Post-endoscopic Retrograde Cholangiopancreatography Pancreatitis: a Meta-analysis. Pancreas. 2014;43(3):338-42. PubMed PMID: 24622061.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The effect of indomethacin in the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis: a meta-analysis. AU - Ahmad,Dina, AU - Lopez,Kristi T, AU - Esmadi,Mohammad A, AU - Oroszi,Gabor, AU - Matteson-Kome,Michelle L, AU - Choudhary,Abhishek, AU - Bechtold,Matthew L, PY - 2014/3/14/entrez PY - 2014/3/14/pubmed PY - 2014/12/17/medline SP - 338 EP - 42 JF - Pancreas JO - Pancreas VL - 43 IS - 3 N2 - OBJECTIVES: Acute pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP) is a severe complication with substantial morbidity and mortality. Indomethacin has been identified to prevent this complication; however, the results using indomethacin have varied. Therefore, we performed a meta-analysis on the efficacy of rectally administered indomethacin in the prevention of post-ERCP pancreatitis (PEP). METHODS: A systematic search was performed in November 2012. Randomized, placebo-controlled trials (randomized controlled trials) in adult patients that compared rectally administered indomethacin versus placebo in prevention of PEP were included. Meta-analysis was performed using a fixed-effects model to assess the primary outcome (PEP) and secondary outcomes (mild or moderate to severe PEP) using Review Manager 5.1. RESULTS: Four randomized controlled trials met the inclusion criteria (n = 1422). The use of indomethacin near the time of ERCP demonstrated a statistically significant decrease in PEP (odds ratio [OR], 0.49; 95% confidence interval [CI], 0.34-0.71; P < 0.01), mild PEP (OR, 0.52; 95% CI, 0.32-0.86; P = 0.01), and moderate to severe PEP (OR, 0.45; 95% CI, 0.24-0.83; P = 0.01) as compared with placebo. The number needed to treat with indomethacin to prevent 1 episode of pancreatitis is 17 patients. CONCLUSIONS: Rectal indomethacin significantly reduced the incidence of PEP. We recommend using indomethacin before or just after the procedure in patients undergoing ERCP. SN - 1536-4828 UR - https://www.unboundmedicine.com/medline/citation/24622061/The_effect_of_indomethacin_in_the_prevention_of_post_endoscopic_retrograde_cholangiopancreatography_pancreatitis:_a_meta_analysis_ L2 - http://Insights.ovid.com/pubmed?pmid=24622061 DB - PRIME DP - Unbound Medicine ER -