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How to select patients and timing for rectal indomethacin to prevent post-ERCP pancreatitis: a systematic review and meta-analysis.
BMC Gastroenterol. 2017 Mar 15; 17(1):43.BG

Abstract

BACKGROUND

Acute pancreatitis is a severe complication of endoscopic retrograde cholangiopancreatography (ERCP). Previous meta-analyses have shown that indomethacin effectively prevents this complication; however, the data are limited. We performed a systematic review and meta-analysis to clarify the applications for rectal indomethacin.

METHODS

A systematic search was performed in June 2016. Human prospective, randomized, placebo-controlled trials that compared rectally administered indomethacin with a placebo for the prevention of post-ERCP pancreatitis (PEP) were included. A meta-analysis was performed using a random-effects model to assess the outcomes (PEP) using Review Manager 5.0.

RESULTS

Seven randomized controlled trials met the inclusion criteria (n = 3013). The overall incidence of PEP was significantly lower after prophylactic administration of rectal indomethacin than after administration of the placebo (RR, 0.58, 95% CI, 0.40-0.83; P = 0.004). A subgroup analysis was performed for rectal indomethacin administration compared to a placebo in high-risk patients (RR, 0.46; 95% CI, 0.32-0.65; P < 0.00001) and average-risk patients (RR, 0.75; 95% CI, 0.46-1.22; P = 0.25) and for administration before ERCP (RR, 0.56; 95% CI, 0.39-0.79; P = 0.001) and after the procedure (RR, 0.61; 95% CI, 0.26-1.44; P = 0.26).

CONCLUSIONS

This meta-analysis indicated that prophylactic rectal indomethacin is not suitable for all patients undergoing ERCP but it is safe and effective to prevent PEP in high-risk patients. In addition, rectal indomethacin administration before ERCP is superior to its administration after ERCP for the prevention of PEP.

Authors+Show Affiliations

Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng Street, Nanchang, Jiangxi, 330006, People's Republic of China.Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng Street, Nanchang, Jiangxi, 330006, People's Republic of China.Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng Street, Nanchang, Jiangxi, 330006, People's Republic of China.Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng Street, Nanchang, Jiangxi, 330006, People's Republic of China. xialiang79@163.com.Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng Street, Nanchang, Jiangxi, 330006, People's Republic of China.

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

28298192

Citation

Wan, Jianhua, et al. "How to Select Patients and Timing for Rectal Indomethacin to Prevent post-ERCP Pancreatitis: a Systematic Review and Meta-analysis." BMC Gastroenterology, vol. 17, no. 1, 2017, p. 43.
Wan J, Ren Y, Zhu Z, et al. How to select patients and timing for rectal indomethacin to prevent post-ERCP pancreatitis: a systematic review and meta-analysis. BMC Gastroenterol. 2017;17(1):43.
Wan, J., Ren, Y., Zhu, Z., Xia, L., & Lu, N. (2017). How to select patients and timing for rectal indomethacin to prevent post-ERCP pancreatitis: a systematic review and meta-analysis. BMC Gastroenterology, 17(1), 43. https://doi.org/10.1186/s12876-017-0599-4
Wan J, et al. How to Select Patients and Timing for Rectal Indomethacin to Prevent post-ERCP Pancreatitis: a Systematic Review and Meta-analysis. BMC Gastroenterol. 2017 Mar 15;17(1):43. PubMed PMID: 28298192.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - How to select patients and timing for rectal indomethacin to prevent post-ERCP pancreatitis: a systematic review and meta-analysis. AU - Wan,Jianhua, AU - Ren,Yuping, AU - Zhu,Zhenhua, AU - Xia,Liang, AU - Lu,Nonghua, Y1 - 2017/03/15/ PY - 2016/11/22/received PY - 2017/03/08/accepted PY - 2017/3/17/entrez PY - 2017/3/17/pubmed PY - 2017/3/24/medline KW - ERCP KW - Indomethacin KW - Meta-analysis KW - Pancreatitis SP - 43 EP - 43 JF - BMC gastroenterology JO - BMC Gastroenterol VL - 17 IS - 1 N2 - BACKGROUND: Acute pancreatitis is a severe complication of endoscopic retrograde cholangiopancreatography (ERCP). Previous meta-analyses have shown that indomethacin effectively prevents this complication; however, the data are limited. We performed a systematic review and meta-analysis to clarify the applications for rectal indomethacin. METHODS: A systematic search was performed in June 2016. Human prospective, randomized, placebo-controlled trials that compared rectally administered indomethacin with a placebo for the prevention of post-ERCP pancreatitis (PEP) were included. A meta-analysis was performed using a random-effects model to assess the outcomes (PEP) using Review Manager 5.0. RESULTS: Seven randomized controlled trials met the inclusion criteria (n = 3013). The overall incidence of PEP was significantly lower after prophylactic administration of rectal indomethacin than after administration of the placebo (RR, 0.58, 95% CI, 0.40-0.83; P = 0.004). A subgroup analysis was performed for rectal indomethacin administration compared to a placebo in high-risk patients (RR, 0.46; 95% CI, 0.32-0.65; P < 0.00001) and average-risk patients (RR, 0.75; 95% CI, 0.46-1.22; P = 0.25) and for administration before ERCP (RR, 0.56; 95% CI, 0.39-0.79; P = 0.001) and after the procedure (RR, 0.61; 95% CI, 0.26-1.44; P = 0.26). CONCLUSIONS: This meta-analysis indicated that prophylactic rectal indomethacin is not suitable for all patients undergoing ERCP but it is safe and effective to prevent PEP in high-risk patients. In addition, rectal indomethacin administration before ERCP is superior to its administration after ERCP for the prevention of PEP. SN - 1471-230X UR - https://www.unboundmedicine.com/medline/citation/28298192/How_to_select_patients_and_timing_for_rectal_indomethacin_to_prevent_post_ERCP_pancreatitis:_a_systematic_review_and_meta_analysis_ L2 - https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-017-0599-4 DB - PRIME DP - Unbound Medicine ER -