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Rectal NSAIDs in the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis in unselected patients: Systematic review and meta-analysis.
Dig Endosc. 2017 May; 29(3):281-290.DE

Abstract

BACKGROUND AND AIM

Efficacy of rectal non-steroidal anti-inflammatory drugs (NSAIDs) for post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) prophylaxis in unselected patients remained controversial. The aim of the present study was to evaluate the efficacy of rectal NSAIDs in the prevention of PEP in unselected patients.

METHODS

An electronic literature search in the Cochrane Library, Embase, and PubMed was carried out for randomized controlled trials comparing rectal indomethacin or diclofenac with placebo in the prevention of PEP in unselected patients. Cochrane risk of bias tool was used to evaluate methodological quality. The data were carried out in forest plots using fixed-effect methods, and random-effect methods were used when heterogeneity was significant.

RESULTS

A total of nine trials were included in our final analysis. Rectal NSAIDs were effective to reduce the incidence of PEP in unselected patients (RR, 0.61; 95% CI, 0.46-0.79), especially for moderate-to-severe PEP (RR, 0.37; 95% CI, 0.17-0.79). Both indomethacin (RR, 0.67; 95% CI, 0.50-0.88) and diclofenac (RR, 0.29; 95% CI, 0.12-0.69) were significantly efficacious. Rectal NSAIDs given pre-ERCP showed significant efficacy (RR, 0.53; 95% CI, 0.39-0.71), whether when given within 30 min pre-ERCP (RR, 0.62; 95% CI, 0.42-0.92) or not (RR, 0.43; 95% CI, 0.28-0.67).

CONCLUSION

Rectal NSAIDs are effective in the prevention of PEP in unselected patients.

Authors+Show Affiliations

The Second Clinical Medical School, Southern Medical University, Guangzhou City, China.The Second Clinical Medical School, Southern Medical University, Guangzhou City, China.The Second Clinical Medical School, Southern Medical University, Guangzhou City, China.Department of Gastroenterology, First People's Hospital of Foshan Affiliated to Sun Yat-sen University, Foshan City, China.

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

28112441

Citation

Shen, Chongrong, et al. "Rectal NSAIDs in the Prevention of Post-endoscopic Retrograde Cholangiopancreatography Pancreatitis in Unselected Patients: Systematic Review and Meta-analysis." Digestive Endoscopy : Official Journal of the Japan Gastroenterological Endoscopy Society, vol. 29, no. 3, 2017, pp. 281-290.
Shen C, Shi Y, Liang T, et al. Rectal NSAIDs in the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis in unselected patients: Systematic review and meta-analysis. Dig Endosc. 2017;29(3):281-290.
Shen, C., Shi, Y., Liang, T., & Su, P. (2017). Rectal NSAIDs in the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis in unselected patients: Systematic review and meta-analysis. Digestive Endoscopy : Official Journal of the Japan Gastroenterological Endoscopy Society, 29(3), 281-290. https://doi.org/10.1111/den.12816
Shen C, et al. Rectal NSAIDs in the Prevention of Post-endoscopic Retrograde Cholangiopancreatography Pancreatitis in Unselected Patients: Systematic Review and Meta-analysis. Dig Endosc. 2017;29(3):281-290. PubMed PMID: 28112441.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Rectal NSAIDs in the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis in unselected patients: Systematic review and meta-analysis. AU - Shen,Chongrong, AU - Shi,Yanqiang, AU - Liang,Tianyu, AU - Su,Peizhu, Y1 - 2017/03/09/ PY - 2016/10/04/received PY - 2017/01/18/accepted PY - 2017/1/24/pubmed PY - 2018/4/5/medline PY - 2017/1/24/entrez KW - diclofenac KW - endoscopic retrograde cholangiopancreatography (ERCP) KW - indomethacin KW - meta-analysis KW - pancreatitis SP - 281 EP - 290 JF - Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society JO - Dig Endosc VL - 29 IS - 3 N2 - BACKGROUND AND AIM: Efficacy of rectal non-steroidal anti-inflammatory drugs (NSAIDs) for post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) prophylaxis in unselected patients remained controversial. The aim of the present study was to evaluate the efficacy of rectal NSAIDs in the prevention of PEP in unselected patients. METHODS: An electronic literature search in the Cochrane Library, Embase, and PubMed was carried out for randomized controlled trials comparing rectal indomethacin or diclofenac with placebo in the prevention of PEP in unselected patients. Cochrane risk of bias tool was used to evaluate methodological quality. The data were carried out in forest plots using fixed-effect methods, and random-effect methods were used when heterogeneity was significant. RESULTS: A total of nine trials were included in our final analysis. Rectal NSAIDs were effective to reduce the incidence of PEP in unselected patients (RR, 0.61; 95% CI, 0.46-0.79), especially for moderate-to-severe PEP (RR, 0.37; 95% CI, 0.17-0.79). Both indomethacin (RR, 0.67; 95% CI, 0.50-0.88) and diclofenac (RR, 0.29; 95% CI, 0.12-0.69) were significantly efficacious. Rectal NSAIDs given pre-ERCP showed significant efficacy (RR, 0.53; 95% CI, 0.39-0.71), whether when given within 30 min pre-ERCP (RR, 0.62; 95% CI, 0.42-0.92) or not (RR, 0.43; 95% CI, 0.28-0.67). CONCLUSION: Rectal NSAIDs are effective in the prevention of PEP in unselected patients. SN - 1443-1661 UR - https://www.unboundmedicine.com/medline/citation/28112441/Rectal_NSAIDs_in_the_prevention_of_post_endoscopic_retrograde_cholangiopancreatography_pancreatitis_in_unselected_patients:_Systematic_review_and_meta_analysis_ L2 - https://doi.org/10.1111/den.12816 DB - PRIME DP - Unbound Medicine ER -