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Prophylactic rectal indomethacin may be ineffective for preventing post-endoscopic retrograde cholangiopancreatography pancreatitis in general patients: A meta-analysis.
Dig Endosc 2017; 29(3):272-280DE

Abstract

BACKGROUND AND AIM

Efficacy of prophylactic indomethacin for prevention of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) in general patients remains controversial. To address this, we conducted a meta-analysis of clinical trials specifically on rectal indomethacin in prevention of PEP in consecutive patients undergoing ERCP.

METHODS

We searched MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials databases to identify randomized, double-blind, controlled clinical trials on rectal indomethacin in the prevention of PEP in consecutive patients undergoing ERCP. Primary outcome was the overall rate of PEP. Secondary outcomes were the overall rates of moderate to severe PEP and mild PEP.

RESULTS

Six studies, with a total of 2473 patients, were included. Overall rate of PEP was 7% (95% CI, 6-9%). No statistical difference was observed in overall rates of PEP (OR, 0.67; 95% CI, 0.46-1.00, P = 0.050) and, additionally, rates of moderate to severe (OR, 0.66; 95% CI, 0.28-1.56, P = 0.345) or mild (OR, 0.71; 95% CI, 0.45-1.10, P = 0.127) PEP between indomethacin and placebo.

CONCLUSION

In a contemporary meta-analysis of available randomized controlled trials of consecutive patients undergoing ERCP, rectal indomethacin did not show significant prevention effect of post-ERCP pancreatitis.

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    Authors+Show Affiliations

    Feng Y
    Center for Interventional Endoscopy, Florida Hospital, Orlando, USA. Department of Gastroenterology, Peking Union Medical College Hospital, Beijing, China.
    Navaneethan U
    Center for Interventional Endoscopy, Florida Hospital, Orlando, USA.
    Zhu X
    Center for Interventional Endoscopy, Florida Hospital, Orlando, USA.
    Varadarajulu S
    Center for Interventional Endoscopy, Florida Hospital, Orlando, USA.
    Schwartz I
    Center for Interventional Endoscopy, Florida Hospital, Orlando, USA. Hospital Sao Lucas, Rio de Janeiro, Brazil.
    Hawes R
    Center for Interventional Endoscopy, Florida Hospital, Orlando, USA.
    Hasan M
    Center for Interventional Endoscopy, Florida Hospital, Orlando, USA.
    Yang A
    Department of Gastroenterology, Peking Union Medical College Hospital, Beijing, China.

    MeSH

    Administration, RectalAnti-Inflammatory Agents, Non-SteroidalCholangiopancreatography, Endoscopic RetrogradeHumansIndomethacinPancreatitisRisk Factors

    Pub Type(s)

    Journal Article
    Meta-Analysis
    Review

    Language

    eng

    PubMed ID

    27914176

    Citation

    Feng, Yunlu, et al. "Prophylactic Rectal Indomethacin May Be Ineffective for Preventing Post-endoscopic Retrograde Cholangiopancreatography Pancreatitis in General Patients: a Meta-analysis." Digestive Endoscopy : Official Journal of the Japan Gastroenterological Endoscopy Society, vol. 29, no. 3, 2017, pp. 272-280.
    Feng Y, Navaneethan U, Zhu X, et al. Prophylactic rectal indomethacin may be ineffective for preventing post-endoscopic retrograde cholangiopancreatography pancreatitis in general patients: A meta-analysis. Dig Endosc. 2017;29(3):272-280.
    Feng, Y., Navaneethan, U., Zhu, X., Varadarajulu, S., Schwartz, I., Hawes, R., ... Yang, A. (2017). Prophylactic rectal indomethacin may be ineffective for preventing post-endoscopic retrograde cholangiopancreatography pancreatitis in general patients: A meta-analysis. Digestive Endoscopy : Official Journal of the Japan Gastroenterological Endoscopy Society, 29(3), pp. 272-280. doi:10.1111/den.12779.
    Feng Y, et al. Prophylactic Rectal Indomethacin May Be Ineffective for Preventing Post-endoscopic Retrograde Cholangiopancreatography Pancreatitis in General Patients: a Meta-analysis. Dig Endosc. 2017;29(3):272-280. PubMed PMID: 27914176.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Prophylactic rectal indomethacin may be ineffective for preventing post-endoscopic retrograde cholangiopancreatography pancreatitis in general patients: A meta-analysis. AU - Feng,Yunlu, AU - Navaneethan,Udayakumar, AU - Zhu,Xiang, AU - Varadarajulu,Shyam, AU - Schwartz,Ingrid, AU - Hawes,Robert, AU - Hasan,Muhammad, AU - Yang,Aiming, Y1 - 2017/01/03/ PY - 2016/09/30/received PY - 2016/11/28/accepted PY - 2016/12/4/pubmed PY - 2018/4/5/medline PY - 2016/12/4/entrez KW - endoscopic retrograde cholangiopancreatography (ERCP) KW - indomethacin KW - meta-analysis KW - pancreatitis KW - prevention SP - 272 EP - 280 JF - Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society JO - Dig Endosc VL - 29 IS - 3 N2 - BACKGROUND AND AIM: Efficacy of prophylactic indomethacin for prevention of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) in general patients remains controversial. To address this, we conducted a meta-analysis of clinical trials specifically on rectal indomethacin in prevention of PEP in consecutive patients undergoing ERCP. METHODS: We searched MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials databases to identify randomized, double-blind, controlled clinical trials on rectal indomethacin in the prevention of PEP in consecutive patients undergoing ERCP. Primary outcome was the overall rate of PEP. Secondary outcomes were the overall rates of moderate to severe PEP and mild PEP. RESULTS: Six studies, with a total of 2473 patients, were included. Overall rate of PEP was 7% (95% CI, 6-9%). No statistical difference was observed in overall rates of PEP (OR, 0.67; 95% CI, 0.46-1.00, P = 0.050) and, additionally, rates of moderate to severe (OR, 0.66; 95% CI, 0.28-1.56, P = 0.345) or mild (OR, 0.71; 95% CI, 0.45-1.10, P = 0.127) PEP between indomethacin and placebo. CONCLUSION: In a contemporary meta-analysis of available randomized controlled trials of consecutive patients undergoing ERCP, rectal indomethacin did not show significant prevention effect of post-ERCP pancreatitis. SN - 1443-1661 UR - https://www.unboundmedicine.com/medline/citation/27914176/Prophylactic_rectal_indomethacin_may_be_ineffective_for_preventing_post_endoscopic_retrograde_cholangiopancreatography_pancreatitis_in_general_patients:_A_meta_analysis_ L2 - https://doi.org/10.1111/den.12779 DB - PRIME DP - Unbound Medicine ER -