Rectal nonsteroidal anti-inflammatory drugs administration is effective for the prevention of post-ERCP pancreatitis: An updated meta-analysis of randomized controlled trials.Pancreatology 2017 Sep - Oct; 17(5):681-688P
Abstract
BACKGROUND
Acute pancreatitis is one of the most common complications of endoscopic retrograde cholangiopancreatography (ERCP). Whether the prophylactic administration of rectal non-steroidal anti-inflammatory drugs (NSAIDs) peri-ERCP is effective in preventing post-ERCP pancreatitis (PEP) remains controversial. The aim of this study was to assess the effect of rectal NSAIDs on PEP.
METHODS
A systematic search of literature databases (Cochrane Library, PubMed, EMBASE, and Web of Science) was performed to identify eligible randomized controlled trials (RCTs). The Jadad score for assessing risk of bias was used to evaluate the quality of included studies. The primary endpoint of the study was efficacy for PEP prevention. Sub-analyses were performed to determine the risk reduction for different NSAID types, for general vs. high-risk patients, by timing of administration and for moderate to severe PEP.
RESULTS
Twelve RCTs, including a total of 3989 patients, were identified and included in the analysis. The risk of PEP was lower in the NSAIDs group than in the placebo group (RR 0.52; 95% CI 0.43-0.64; P < 0.01). The risk of moderate to severe PEP was also lower in the NSAIDs group. (RR 0.44; 95% CI 0.28-0.69; P < 0.01). There was no difference in efficacy between rectal indomethacin and diclofenac, nor between pre-ERCP and post-ERCP administration timing of rectal NSAIDs.
CONCLUSIONS
A single rectal dose of NSAIDs is effective in preventing PEP both in high-risk and in unselected patients, regardless of timing of administration (pre- or post-ERCP) and NSAID type (indomethacin or diclofenac).
MeSH
Pub Type(s)
Journal Article
Meta-Analysis
Language
eng
PubMed ID
28734720
Citation
Yang, Chong, et al. "Rectal Nonsteroidal Anti-inflammatory Drugs Administration Is Effective for the Prevention of post-ERCP Pancreatitis: an Updated Meta-analysis of Randomized Controlled Trials." Pancreatology : Official Journal of the International Association of Pancreatology (IAP) ... [et Al.], vol. 17, no. 5, 2017, pp. 681-688.
Yang C, Zhao Y, Li W, et al. Rectal nonsteroidal anti-inflammatory drugs administration is effective for the prevention of post-ERCP pancreatitis: An updated meta-analysis of randomized controlled trials. Pancreatology. 2017;17(5):681-688.
Yang, C., Zhao, Y., Li, W., Zhu, S., Yang, H., Zhang, Y., ... Jin, X. (2017). Rectal nonsteroidal anti-inflammatory drugs administration is effective for the prevention of post-ERCP pancreatitis: An updated meta-analysis of randomized controlled trials. Pancreatology : Official Journal of the International Association of Pancreatology (IAP) ... [et Al.], 17(5), pp. 681-688. doi:10.1016/j.pan.2017.07.008.
Yang C, et al. Rectal Nonsteroidal Anti-inflammatory Drugs Administration Is Effective for the Prevention of post-ERCP Pancreatitis: an Updated Meta-analysis of Randomized Controlled Trials. Pancreatology. 2017;17(5):681-688. PubMed PMID: 28734720.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR
T1 - Rectal nonsteroidal anti-inflammatory drugs administration is effective for the prevention of post-ERCP pancreatitis: An updated meta-analysis of randomized controlled trials.
AU - Yang,Chong,
AU - Zhao,Yanting,
AU - Li,Wentao,
AU - Zhu,Shikai,
AU - Yang,Hongji,
AU - Zhang,Yu,
AU - Liu,Xi,
AU - Peng,Nan,
AU - Fan,Ping,
AU - Jin,Xin,
Y1 - 2017/07/17/
PY - 2017/02/20/received
PY - 2017/06/20/revised
PY - 2017/07/16/accepted
PY - 2017/7/25/pubmed
PY - 2018/6/12/medline
PY - 2017/7/24/entrez
KW - ERCP
KW - Meta-analysis
KW - NSAIDs
KW - PEP
KW - Rectal
SP - 681
EP - 688
JF - Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.]
JO - Pancreatology
VL - 17
IS - 5
N2 - BACKGROUND: Acute pancreatitis is one of the most common complications of endoscopic retrograde cholangiopancreatography (ERCP). Whether the prophylactic administration of rectal non-steroidal anti-inflammatory drugs (NSAIDs) peri-ERCP is effective in preventing post-ERCP pancreatitis (PEP) remains controversial. The aim of this study was to assess the effect of rectal NSAIDs on PEP. METHODS: A systematic search of literature databases (Cochrane Library, PubMed, EMBASE, and Web of Science) was performed to identify eligible randomized controlled trials (RCTs). The Jadad score for assessing risk of bias was used to evaluate the quality of included studies. The primary endpoint of the study was efficacy for PEP prevention. Sub-analyses were performed to determine the risk reduction for different NSAID types, for general vs. high-risk patients, by timing of administration and for moderate to severe PEP. RESULTS: Twelve RCTs, including a total of 3989 patients, were identified and included in the analysis. The risk of PEP was lower in the NSAIDs group than in the placebo group (RR 0.52; 95% CI 0.43-0.64; P < 0.01). The risk of moderate to severe PEP was also lower in the NSAIDs group. (RR 0.44; 95% CI 0.28-0.69; P < 0.01). There was no difference in efficacy between rectal indomethacin and diclofenac, nor between pre-ERCP and post-ERCP administration timing of rectal NSAIDs. CONCLUSIONS: A single rectal dose of NSAIDs is effective in preventing PEP both in high-risk and in unselected patients, regardless of timing of administration (pre- or post-ERCP) and NSAID type (indomethacin or diclofenac).
SN - 1424-3911
UR - https://www.unboundmedicine.com/medline/citation/28734720/Rectal_nonsteroidal_anti_inflammatory_drugs_administration_is_effective_for_the_prevention_of_post_ERCP_pancreatitis:_An_updated_meta_analysis_of_randomized_controlled_trials_
L2 - https://linkinghub.elsevier.com/retrieve/pii/S1424-3903(17)30528-8
DB - PRIME
DP - Unbound Medicine
ER -
