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Prevention effect of allopurinol on post-endoscopic retrograde cholangiopancreatography pancreatitis: a meta-analysis of prospective randomized controlled trials.
PLoS One 2014; 9(9):e107350Plos

Abstract

BACKGROUND

Pancreatitis is the most common complication of endoscopic retrograde cholangiopancreatography (ERCP) which can be severe and cause death in approximately 10% of cases. Up to now, six randomized controlled trials (RCTs) have been found relevant to the effect of allopurinol on prevention of Post-ERCP pancreatitis (PEP). However, these results remained controversial.

OBJECTIVE

To conduct a meta-analysis with RCTs published in full text to determine the effectiveness of prophylactic allopurinol of different dosages and administration time in the incidence and severity of PEP.

METHODS

Literature search was performed in PubMed, Embase, Web of Science and Cochrane Library from databases inception to May 2014. RCTs comparing the effect of allopurinol with placebo on prevention of PEP were included. Statistical heterogeneity was quantitatively evaluated byχ2 test with the significance set P<0.10 or I2>50%.

RESULTS

Six RCTs consisting of 1974 participants were eventually included. The incidences of PEP in allopurinol group and placebo group were 8.4%(83/986) and 9.9%(98/988) respectively. Meta-analysis showed no evident prevention effect of allopurinol on the incidence of PEP (RR 0.75, 95%CI 0.39-1.42) with significant heterogeneity (I2 = 70.4%, P = 0.005). When studies were stratified according to the dosages and administration time of allopurinol they applied, there was still no evident prevention effect of allopurinol on mild, moderate or severe PEP. However, statistically substantial heterogeneity was presented in the subgroup of moderate PEP when the effect of high dose of allopurinol was analyzed (Imoderate2 = 82.3%, Pmoderate = 0.018). Statistically significant heterogeneity was also observed in subgroup of mild PEP, when the effect of long adminstration time of allopurinol was investigated (Imild2 = 62.8%, Pmild = 0.068).

CONCLUSION

The prophylactic use of allopurinol in different dosages and administration time had no effect in preventing incidence and severity of PEP.

Authors+Show Affiliations

Postgraduate Training Base, Affiliated Hospital of Logistics University of the Chinese People's Armed Police Forces, Liaoning Medical University, Jinzhou, China; Department of Hepatopancreatobiliary and Splenic Medicine, Affiliated Hospital of Logistics University of the Chinese People's Armed Police Forces, Tianjin, China.Postgraduate Training Base, Affiliated Hospital of Logistics University of the Chinese People's Armed Police Forces, Liaoning Medical University, Jinzhou, China; Department of Endemic Area of Orthopedic Center Section III, Affiliated Hospital of Logistics University of the Chinese People's Armed Police Forces, Tianjin, China.Department of Hepatopancreatobiliary and Splenic Medicine, Affiliated Hospital of Logistics University of the Chinese People's Armed Police Forces, Tianjin, China.Department of Hepatopancreatobiliary and Splenic Medicine, Affiliated Hospital of Logistics University of the Chinese People's Armed Police Forces, Tianjin, China.Postgraduate Training Base, Affiliated Hospital of Logistics University of the Chinese People's Armed Police Forces, Liaoning Medical University, Jinzhou, China; Department of Hepatopancreatobiliary and Splenic Medicine, Affiliated Hospital of Logistics University of the Chinese People's Armed Police Forces, Tianjin, China.

Pub Type(s)

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

Language

eng

PubMed ID

25202907

Citation

Cao, Wei-Li, et al. "Prevention Effect of Allopurinol On Post-endoscopic Retrograde Cholangiopancreatography Pancreatitis: a Meta-analysis of Prospective Randomized Controlled Trials." PloS One, vol. 9, no. 9, 2014, pp. e107350.
Cao WL, Yan WS, Xiang XH, et al. Prevention effect of allopurinol on post-endoscopic retrograde cholangiopancreatography pancreatitis: a meta-analysis of prospective randomized controlled trials. PLoS ONE. 2014;9(9):e107350.
Cao, W. L., Yan, W. S., Xiang, X. H., Chen, K., & Xia, S. H. (2014). Prevention effect of allopurinol on post-endoscopic retrograde cholangiopancreatography pancreatitis: a meta-analysis of prospective randomized controlled trials. PloS One, 9(9), pp. e107350. doi:10.1371/journal.pone.0107350.
Cao WL, et al. Prevention Effect of Allopurinol On Post-endoscopic Retrograde Cholangiopancreatography Pancreatitis: a Meta-analysis of Prospective Randomized Controlled Trials. PLoS ONE. 2014;9(9):e107350. PubMed PMID: 25202907.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prevention effect of allopurinol on post-endoscopic retrograde cholangiopancreatography pancreatitis: a meta-analysis of prospective randomized controlled trials. AU - Cao,Wei-Li, AU - Yan,Wen-Shan, AU - Xiang,Xiao-Hui, AU - Chen,Kai, AU - Xia,Shi-Hai, Y1 - 2014/09/09/ PY - 2014/05/31/received PY - 2014/08/14/accepted PY - 2014/9/10/entrez PY - 2014/9/10/pubmed PY - 2015/5/29/medline SP - e107350 EP - e107350 JF - PloS one JO - PLoS ONE VL - 9 IS - 9 N2 - BACKGROUND: Pancreatitis is the most common complication of endoscopic retrograde cholangiopancreatography (ERCP) which can be severe and cause death in approximately 10% of cases. Up to now, six randomized controlled trials (RCTs) have been found relevant to the effect of allopurinol on prevention of Post-ERCP pancreatitis (PEP). However, these results remained controversial. OBJECTIVE: To conduct a meta-analysis with RCTs published in full text to determine the effectiveness of prophylactic allopurinol of different dosages and administration time in the incidence and severity of PEP. METHODS: Literature search was performed in PubMed, Embase, Web of Science and Cochrane Library from databases inception to May 2014. RCTs comparing the effect of allopurinol with placebo on prevention of PEP were included. Statistical heterogeneity was quantitatively evaluated byχ2 test with the significance set P<0.10 or I2>50%. RESULTS: Six RCTs consisting of 1974 participants were eventually included. The incidences of PEP in allopurinol group and placebo group were 8.4%(83/986) and 9.9%(98/988) respectively. Meta-analysis showed no evident prevention effect of allopurinol on the incidence of PEP (RR 0.75, 95%CI 0.39-1.42) with significant heterogeneity (I2 = 70.4%, P = 0.005). When studies were stratified according to the dosages and administration time of allopurinol they applied, there was still no evident prevention effect of allopurinol on mild, moderate or severe PEP. However, statistically substantial heterogeneity was presented in the subgroup of moderate PEP when the effect of high dose of allopurinol was analyzed (Imoderate2 = 82.3%, Pmoderate = 0.018). Statistically significant heterogeneity was also observed in subgroup of mild PEP, when the effect of long adminstration time of allopurinol was investigated (Imild2 = 62.8%, Pmild = 0.068). CONCLUSION: The prophylactic use of allopurinol in different dosages and administration time had no effect in preventing incidence and severity of PEP. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/25202907/Prevention_effect_of_allopurinol_on_post_endoscopic_retrograde_cholangiopancreatography_pancreatitis:_a_meta_analysis_of_prospective_randomized_controlled_trials_ L2 - http://dx.plos.org/10.1371/journal.pone.0107350 DB - PRIME DP - Unbound Medicine ER -