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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):681-688.P

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).

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Authors+Show Affiliations

Organ Transplantation Center, Hospital of the University of Electronic Science and Technology of China and Sichuan Provincial People's Hospital, Chengdu 610072, Sichuan, PR China.

Department of Health Education, Chengdu Centers for Diseases Control and Prevention, Chengdu 610041, Sichuan, PR China.

Organ Transplantation Center, Hospital of the University of Electronic Science and Technology of China and Sichuan Provincial People's Hospital, Chengdu 610072, Sichuan, PR China.

Organ Transplantation Center, Hospital of the University of Electronic Science and Technology of China and Sichuan Provincial People's Hospital, Chengdu 610072, Sichuan, PR China.

Organ Transplantation Center, Hospital of the University of Electronic Science and Technology of China and Sichuan Provincial People's Hospital, Chengdu 610072, Sichuan, PR China.

Organ Transplantation Center, Hospital of the University of Electronic Science and Technology of China and Sichuan Provincial People's Hospital, Chengdu 610072, Sichuan, PR China.

Department of Health Education, Chengdu Centers for Diseases Control and Prevention, Chengdu 610041, Sichuan, PR China.

Department of Health Education, Chengdu Centers for Diseases Control and Prevention, Chengdu 610041, Sichuan, PR China.

Department of Digestive Surgical Oncology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei, PR China.

Department of Digestive Surgical Oncology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei, PR China. Electronic address: dadajin888@163.com.

MeSH

Administration, RectalAnti-Inflammatory Agents, Non-SteroidalCholangiopancreatography, Endoscopic RetrogradeHumansPancreatitisPostoperative ComplicationsRandomized Controlled Trials as Topic

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., Liu, X., Peng, N., Fan, P., & 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), 681-688. https://doi.org/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 Sep - Oct;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 -