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Effectiveness of nonsteroidal anti-inflammatory drugs in prevention of post-ERCP pancreatitis: a meta-analysis.
World J Gastroenterol 2014; 20(34):12322-9WJ

Abstract

AIM

To investigate the effect of nonsteroidal anti-inflammatory drugs (NSAIDs) on the incidence of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP).

METHODS

Two independent reviewers searched PubMed (1966 to October 2013), Embase (1984 to October 2013) and the Cochrane Central Register of Controlled Trials (CENTRAL; Issue 4, 2013) for relevant randomized controlled trials (RCTs) studying the effectiveness of prophylactic NSAID administration in the prevention of PEP. Using the Cochrane Collaboration Handbook, meta-analyses were conducted to evaluate the overall effect of NSAIDs in preventing the incidences of PEP and moderate to severe pancreatitis.

RESULTS

Eight RCTs were identified from the literature search and included 1883 patients that underwent ERCP, with 971 patients in the NSAID group and 912 patients in the placebo group. Sixty-nine out of 971 (7.11%) patients developed PEP in the NSAID group in comparison to 143 out of 912 (15.68%) patients in the placebo group. The pooled RR of PEP incidence with prophylactic NSAID administration was 0.43 (95%CI: 0.33-0.56), which demonstrates that NSAID administration after ERCP significantly reduced the incidence of PEP when compared to the placebo group (P < 0.0001). Subgroup analysis was performed and revealed that the presence (NSAID group) or absence (placebo group) of NSAIDs had no significant effect on the development of moderate to severe pancreatitis (RR = 0.79, 95%CI: 0.52-1.18). Moreover, the administration of NSAIDs as a rectal suppository (RR = 0.35, 95%CI: 0.26-0.48; P < 0.0001) was more effective than oral administration (RR = 0.97, 95%CI: 0.53-1.80) or through infusion (RR = 0.43, 95%CI: 0.12-1.54).

CONCLUSION

NSAIDs effectively reduce the incidence of PEP but not of moderate to severe pancreatitis.

Authors+Show Affiliations

Xiao Li, Li-Ping Tao, Chun-Hui Wang, Department of Gastroenterology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.Xiao Li, Li-Ping Tao, Chun-Hui Wang, Department of Gastroenterology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.Xiao Li, Li-Ping Tao, Chun-Hui Wang, Department of Gastroenterology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.

Pub Type(s)

Journal Article
Meta-Analysis
Review

Language

eng

PubMed ID

25232268

Citation

Li, Xiao, et al. "Effectiveness of Nonsteroidal Anti-inflammatory Drugs in Prevention of post-ERCP Pancreatitis: a Meta-analysis." World Journal of Gastroenterology, vol. 20, no. 34, 2014, pp. 12322-9.
Li X, Tao LP, Wang CH. Effectiveness of nonsteroidal anti-inflammatory drugs in prevention of post-ERCP pancreatitis: a meta-analysis. World J Gastroenterol. 2014;20(34):12322-9.
Li, X., Tao, L. P., & Wang, C. H. (2014). Effectiveness of nonsteroidal anti-inflammatory drugs in prevention of post-ERCP pancreatitis: a meta-analysis. World Journal of Gastroenterology, 20(34), pp. 12322-9. doi:10.3748/wjg.v20.i34.12322.
Li X, Tao LP, Wang CH. Effectiveness of Nonsteroidal Anti-inflammatory Drugs in Prevention of post-ERCP Pancreatitis: a Meta-analysis. World J Gastroenterol. 2014 Sep 14;20(34):12322-9. PubMed PMID: 25232268.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effectiveness of nonsteroidal anti-inflammatory drugs in prevention of post-ERCP pancreatitis: a meta-analysis. AU - Li,Xiao, AU - Tao,Li-Ping, AU - Wang,Chun-Hui, PY - 2014/01/19/received PY - 2014/03/10/revised PY - 2014/04/30/accepted PY - 2014/9/19/entrez PY - 2014/9/19/pubmed PY - 2015/5/16/medline KW - Meta-analysis KW - Nonsteroidal anti-inflammatory drugs KW - Post-endoscopic retrograde cholangiopancreatography pancreatitis KW - Randomized controlled trial SP - 12322 EP - 9 JF - World journal of gastroenterology JO - World J. Gastroenterol. VL - 20 IS - 34 N2 - AIM: To investigate the effect of nonsteroidal anti-inflammatory drugs (NSAIDs) on the incidence of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). METHODS: Two independent reviewers searched PubMed (1966 to October 2013), Embase (1984 to October 2013) and the Cochrane Central Register of Controlled Trials (CENTRAL; Issue 4, 2013) for relevant randomized controlled trials (RCTs) studying the effectiveness of prophylactic NSAID administration in the prevention of PEP. Using the Cochrane Collaboration Handbook, meta-analyses were conducted to evaluate the overall effect of NSAIDs in preventing the incidences of PEP and moderate to severe pancreatitis. RESULTS: Eight RCTs were identified from the literature search and included 1883 patients that underwent ERCP, with 971 patients in the NSAID group and 912 patients in the placebo group. Sixty-nine out of 971 (7.11%) patients developed PEP in the NSAID group in comparison to 143 out of 912 (15.68%) patients in the placebo group. The pooled RR of PEP incidence with prophylactic NSAID administration was 0.43 (95%CI: 0.33-0.56), which demonstrates that NSAID administration after ERCP significantly reduced the incidence of PEP when compared to the placebo group (P < 0.0001). Subgroup analysis was performed and revealed that the presence (NSAID group) or absence (placebo group) of NSAIDs had no significant effect on the development of moderate to severe pancreatitis (RR = 0.79, 95%CI: 0.52-1.18). Moreover, the administration of NSAIDs as a rectal suppository (RR = 0.35, 95%CI: 0.26-0.48; P < 0.0001) was more effective than oral administration (RR = 0.97, 95%CI: 0.53-1.80) or through infusion (RR = 0.43, 95%CI: 0.12-1.54). CONCLUSION: NSAIDs effectively reduce the incidence of PEP but not of moderate to severe pancreatitis. SN - 2219-2840 UR - https://www.unboundmedicine.com/medline/citation/25232268/Effectiveness_of_nonsteroidal_anti_inflammatory_drugs_in_prevention_of_post_ERCP_pancreatitis:_a_meta_analysis_ L2 - http://www.wjgnet.com/1007-9327/full/v20/i34/12322.htm DB - PRIME DP - Unbound Medicine ER -