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Endoscopic and pharmacological treatment for prophylaxis against postendoscopic retrograde cholangiopancreatography pancreatitis: a meta-analysis and systematic review.
Eur J Gastroenterol Hepatol 2016; 28(12):1415-1424EJ

Abstract

BACKGROUND AND AIM

Postendoscopic retrograde cholangiopancreatography (post-ERCP) pancreatitis (PEP) is the most common complication following ERCP. We carried out a systematic review and meta-analysis of the global literature on PEP prevention to provide clinical guidance and a framework for future research in this important field.

METHODS

PubMed, Embase, Science Citation Index, Ovid, and the Cochrane Controlled Trials Register were searched by two independent reviewers to identify full-length, prospective, randomized controlled trials (RCTs) published up until March 2016 investigating the use of pancreatic duct stents and pharmacological agents to prevent PEP.

RESULTS

Twelve RCTs comparing the risk of PEP after pancreatic duct stent placement (1369 patients) and 30 RCTs comparing pharmacological agents over placebo (10251 patients) fulfilled the inclusion criteria and were selected for final review and analysis. Meta-analysis showed that prophylactic pancreatic stents significantly decreased the odds of post-ERCP pancreatitis [odds ratio (OR), 0.28; 95% confidence interval (CI), 0.18-0.42]. Significant OR reduction of PEP was also observed in relation to rectal administration of diclofenac (OR, 0.24; 95% CI, 0.12-0.48) and rectal administration of indometacin (OR, 0.59; 95% CI, 0.44-0.79) compared with placebo. Subgroup analysis showed a significant reduction with bolus-administered somatostatin (OR, 0.23; 95% CI, 0.11-0.49). Subgroup analysis showed a significant reduction with bolus-administered somatostatin (OR, 0.23; 95% CI, 0.11-0.49).

CONCLUSION

Pancreatic stent placement, rectal diclofenac, and bolus administration of somatostatin appear to be most effective in preventing post-ERCP pancreatitis.

Authors+Show Affiliations

aDepartment of Gastroenterology and Digestive Endoscopy, Academic Center 'Santa Maria della Misericordia', Udine, Italy bDepartment of Internal Medicine, Regionalspital Emmental AG, Langnau im Emmental, Switzerland cUniversity Clinical-Hospital Center 'Dr Dragisa Misovic-Dedinje' dFaculty of Medicine, University of Belgrade, Belgrade, Serbia.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

27580214

Citation

Vadalà di Prampero, Salvatore F., et al. "Endoscopic and Pharmacological Treatment for Prophylaxis Against Postendoscopic Retrograde Cholangiopancreatography Pancreatitis: a Meta-analysis and Systematic Review." European Journal of Gastroenterology & Hepatology, vol. 28, no. 12, 2016, pp. 1415-1424.
Vadalà di Prampero SF, Faleschini G, Panic N, et al. Endoscopic and pharmacological treatment for prophylaxis against postendoscopic retrograde cholangiopancreatography pancreatitis: a meta-analysis and systematic review. Eur J Gastroenterol Hepatol. 2016;28(12):1415-1424.
Vadalà di Prampero, S. F., Faleschini, G., Panic, N., & Bulajic, M. (2016). Endoscopic and pharmacological treatment for prophylaxis against postendoscopic retrograde cholangiopancreatography pancreatitis: a meta-analysis and systematic review. European Journal of Gastroenterology & Hepatology, 28(12), pp. 1415-1424.
Vadalà di Prampero SF, et al. Endoscopic and Pharmacological Treatment for Prophylaxis Against Postendoscopic Retrograde Cholangiopancreatography Pancreatitis: a Meta-analysis and Systematic Review. Eur J Gastroenterol Hepatol. 2016;28(12):1415-1424. PubMed PMID: 27580214.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Endoscopic and pharmacological treatment for prophylaxis against postendoscopic retrograde cholangiopancreatography pancreatitis: a meta-analysis and systematic review. AU - Vadalà di Prampero,Salvatore F, AU - Faleschini,Giacomo, AU - Panic,Nikola, AU - Bulajic,Milutin, PY - 2016/10/21/pubmed PY - 2017/6/24/medline PY - 2016/9/1/entrez SP - 1415 EP - 1424 JF - European journal of gastroenterology & hepatology JO - Eur J Gastroenterol Hepatol VL - 28 IS - 12 N2 - BACKGROUND AND AIM: Postendoscopic retrograde cholangiopancreatography (post-ERCP) pancreatitis (PEP) is the most common complication following ERCP. We carried out a systematic review and meta-analysis of the global literature on PEP prevention to provide clinical guidance and a framework for future research in this important field. METHODS: PubMed, Embase, Science Citation Index, Ovid, and the Cochrane Controlled Trials Register were searched by two independent reviewers to identify full-length, prospective, randomized controlled trials (RCTs) published up until March 2016 investigating the use of pancreatic duct stents and pharmacological agents to prevent PEP. RESULTS: Twelve RCTs comparing the risk of PEP after pancreatic duct stent placement (1369 patients) and 30 RCTs comparing pharmacological agents over placebo (10251 patients) fulfilled the inclusion criteria and were selected for final review and analysis. Meta-analysis showed that prophylactic pancreatic stents significantly decreased the odds of post-ERCP pancreatitis [odds ratio (OR), 0.28; 95% confidence interval (CI), 0.18-0.42]. Significant OR reduction of PEP was also observed in relation to rectal administration of diclofenac (OR, 0.24; 95% CI, 0.12-0.48) and rectal administration of indometacin (OR, 0.59; 95% CI, 0.44-0.79) compared with placebo. Subgroup analysis showed a significant reduction with bolus-administered somatostatin (OR, 0.23; 95% CI, 0.11-0.49). Subgroup analysis showed a significant reduction with bolus-administered somatostatin (OR, 0.23; 95% CI, 0.11-0.49). CONCLUSION: Pancreatic stent placement, rectal diclofenac, and bolus administration of somatostatin appear to be most effective in preventing post-ERCP pancreatitis. SN - 1473-5687 UR - https://www.unboundmedicine.com/medline/citation/27580214/Endoscopic_and_pharmacological_treatment_for_prophylaxis_against_postendoscopic_retrograde_cholangiopancreatography_pancreatitis:_a_meta_analysis_and_systematic_review_ L2 - http://Insights.ovid.com/pubmed?pmid=27580214 DB - PRIME DP - Unbound Medicine ER -