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Indomethacin and diclofenac in the prevention of post-ERCP pancreatitis: a systematic review and meta-analysis of prospective controlled trials.
Gastrointest Endosc 2017; 85(6):1144-1156.e1GE

Abstract

BACKGROUND AND AIMS

Diclofenac and indomethacin are the most studied drugs for preventing post-ERCP pancreatitis (PEP). However, there are no prospective, randomized multicenter trials with a sufficient number of patients for correct evaluation of their efficacy. Our aim was to evaluate all prospective trials published in full text that studied the efficacy of diclofenac or indomethacin and were controlled with placebo or non-treatment for the prevention of PEP in adult patients undergoing ERCP.

METHODS

Systematic search of databases (PubMed, Scopus, Web of Science, Cochrane) for relevant studies published from inception to 30 June 2016.

RESULTS

Our meta-analysis of 4741 patients from 17 trials showed that diclofenac or indomethacin significantly decreased the risk ratio (RR) of PEP to 0.60 (95% confidence interval [CI], 0.46-0.78; P = .0001), number needed to treat (NNT) was 20, and the reduction of RR of moderate to severe PEP was 0.64 (95% CI, 0.43-0.97; P = .0339). The efficacy of indomethacin compared with diclofenac was similar (P = .98). The efficacy of indomethacin or diclofenac did not differ according to timing (P = .99) or between patients with average-risk and high-risk for PEP (P = .6923). The effect of non-rectal administration of indomethacin or diclofenac was not significant (P = .1507), but the rectal route was very effective (P = .0005) with an NNT of 19. The administration of indomethacin or diclofenac was avoided in patients with renal failure. Substantial adverse events were not detected.

CONCLUSIONS

The use of rectally administered diclofenac or indomethacin before or closely after ERCP is inexpensive and safe and is recommended in every patient (without renal failure) undergoing ERCP. (Registration number: CRD42016042726, http://www.crd.york.ac.uk/prospero/.).

Authors+Show Affiliations

Department of Gastroenterology and Medicine, Markusovszky University Teaching Hospital, Szombathely, Hungary.Biometeorology Research Group, University of Veterinary Medicine, Budapest, Hungary.Department of Computer Science, Corvinus University of Budapest, Budapest, Hungary.2nd Department of Medicine, Semmelweis University, Budapest, Hungary.

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

28167118

Citation

Patai, Árpád, et al. "Indomethacin and Diclofenac in the Prevention of post-ERCP Pancreatitis: a Systematic Review and Meta-analysis of Prospective Controlled Trials." Gastrointestinal Endoscopy, vol. 85, no. 6, 2017, pp. 1144-1156.e1.
Patai Á, Solymosi N, Mohácsi L, et al. Indomethacin and diclofenac in the prevention of post-ERCP pancreatitis: a systematic review and meta-analysis of prospective controlled trials. Gastrointest Endosc. 2017;85(6):1144-1156.e1.
Patai, Á., Solymosi, N., Mohácsi, L., & Patai, Á. V. (2017). Indomethacin and diclofenac in the prevention of post-ERCP pancreatitis: a systematic review and meta-analysis of prospective controlled trials. Gastrointestinal Endoscopy, 85(6), pp. 1144-1156.e1. doi:10.1016/j.gie.2017.01.033.
Patai Á, et al. Indomethacin and Diclofenac in the Prevention of post-ERCP Pancreatitis: a Systematic Review and Meta-analysis of Prospective Controlled Trials. Gastrointest Endosc. 2017;85(6):1144-1156.e1. PubMed PMID: 28167118.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Indomethacin and diclofenac in the prevention of post-ERCP pancreatitis: a systematic review and meta-analysis of prospective controlled trials. AU - Patai,Árpád, AU - Solymosi,Norbert, AU - Mohácsi,László, AU - Patai,Árpád V, Y1 - 2017/02/04/ PY - 2016/11/15/received PY - 2017/01/16/accepted PY - 2017/2/9/pubmed PY - 2018/3/23/medline PY - 2017/2/8/entrez SP - 1144 EP - 1156.e1 JF - Gastrointestinal endoscopy JO - Gastrointest. Endosc. VL - 85 IS - 6 N2 - BACKGROUND AND AIMS: Diclofenac and indomethacin are the most studied drugs for preventing post-ERCP pancreatitis (PEP). However, there are no prospective, randomized multicenter trials with a sufficient number of patients for correct evaluation of their efficacy. Our aim was to evaluate all prospective trials published in full text that studied the efficacy of diclofenac or indomethacin and were controlled with placebo or non-treatment for the prevention of PEP in adult patients undergoing ERCP. METHODS: Systematic search of databases (PubMed, Scopus, Web of Science, Cochrane) for relevant studies published from inception to 30 June 2016. RESULTS: Our meta-analysis of 4741 patients from 17 trials showed that diclofenac or indomethacin significantly decreased the risk ratio (RR) of PEP to 0.60 (95% confidence interval [CI], 0.46-0.78; P = .0001), number needed to treat (NNT) was 20, and the reduction of RR of moderate to severe PEP was 0.64 (95% CI, 0.43-0.97; P = .0339). The efficacy of indomethacin compared with diclofenac was similar (P = .98). The efficacy of indomethacin or diclofenac did not differ according to timing (P = .99) or between patients with average-risk and high-risk for PEP (P = .6923). The effect of non-rectal administration of indomethacin or diclofenac was not significant (P = .1507), but the rectal route was very effective (P = .0005) with an NNT of 19. The administration of indomethacin or diclofenac was avoided in patients with renal failure. Substantial adverse events were not detected. CONCLUSIONS: The use of rectally administered diclofenac or indomethacin before or closely after ERCP is inexpensive and safe and is recommended in every patient (without renal failure) undergoing ERCP. (Registration number: CRD42016042726, http://www.crd.york.ac.uk/prospero/.). SN - 1097-6779 UR - https://www.unboundmedicine.com/medline/citation/28167118/Indomethacin_and_diclofenac_in_the_prevention_of_post_ERCP_pancreatitis:_a_systematic_review_and_meta_analysis_of_prospective_controlled_trials_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016-5107(17)30077-9 DB - PRIME DP - Unbound Medicine ER -