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Nonsteroidal Anti-inflammatory Drugs for Endoscopic Retrograde Cholangiopancreatography Postoperative Pancreatitis Prevention: a Systematic Review and Meta-analysis.
J Gastrointest Surg. 2019 10; 23(10):1991-2001.JG

Abstract

BACKGROUND OR PURPOSE

There is controversy regarding the efficacy of nonsteroidal anti-inflammatory drugs (NSAIDs) for prophylaxis against endoscopic retrograde cholangiopancreatography (ERCP) postoperative pancreatitis. Therefore, we conducted a systematic review and meta-analysis to evaluate the efficacy of NSAIDs for prophylaxis against post-ERCP pancreatitis (PEP).

METHODS

PubMed, EMBASE, and Cochrane library databases were searched for relevant randomized controlled trials (RCTs). Selected RCTs were pooled under a fixed effects model to generate the relative risks (RRs) and their corresponding 95% confidence intervals (CIs).

RESULTS

Nineteen RCTs involving a total of 5031 patients (2555 in the intervention group and 2476 in the control group) were selected. Overall, NSAIDs were associated with a significant reduction in risk of PEP (RR = 0.54, 95% CI 0.45 to 0.64, I2 = 40.4%) and moderate to severe PEP (RR = 0.45, 95% CI 0.30 to 0.67, I2 = 0%) compared with the control group. Subgroup analyses were performed according to route of administration (rectal or other), type of NSAIDs (diclofenac, indomethacin, or other), timing of administration (pre-ERCP, post-ERCP, or other), and patient population (high risk or general). Subgroup analyses showed difference in clinical efficacy of NSAID prophylaxis regardless of route, timing, or specific type of NSAID.

CONCLUSION

NSAIDs were associated with a significant reduction in risk of PEP and moderate to severe PEP compared to the control group.

Authors+Show Affiliations

Department of Pathology, Affiliated Hospital of Yanbian University, Yanji, 133000, China.Department of Gastroenterology and Hepatology, Affiliated Hospital of Yanbian University, Yanji, 133000, China.Department of Gastroenterology and Hepatology, Affiliated Hospital of Yanbian University, Yanji, 133000, China.Department of Gastroenterology and Hepatology, Affiliated Hospital of Yanbian University, Yanji, 133000, China. jinhyyj@msn.com.

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review

Language

eng

PubMed ID

30251071

Citation

Liu, Lan, et al. "Nonsteroidal Anti-inflammatory Drugs for Endoscopic Retrograde Cholangiopancreatography Postoperative Pancreatitis Prevention: a Systematic Review and Meta-analysis." Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract, vol. 23, no. 10, 2019, pp. 1991-2001.
Liu L, Li C, Huang Y, et al. Nonsteroidal Anti-inflammatory Drugs for Endoscopic Retrograde Cholangiopancreatography Postoperative Pancreatitis Prevention: a Systematic Review and Meta-analysis. J Gastrointest Surg. 2019;23(10):1991-2001.
Liu, L., Li, C., Huang, Y., & Jin, H. (2019). Nonsteroidal Anti-inflammatory Drugs for Endoscopic Retrograde Cholangiopancreatography Postoperative Pancreatitis Prevention: a Systematic Review and Meta-analysis. Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract, 23(10), 1991-2001. https://doi.org/10.1007/s11605-018-3967-7
Liu L, et al. Nonsteroidal Anti-inflammatory Drugs for Endoscopic Retrograde Cholangiopancreatography Postoperative Pancreatitis Prevention: a Systematic Review and Meta-analysis. J Gastrointest Surg. 2019;23(10):1991-2001. PubMed PMID: 30251071.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Nonsteroidal Anti-inflammatory Drugs for Endoscopic Retrograde Cholangiopancreatography Postoperative Pancreatitis Prevention: a Systematic Review and Meta-analysis. AU - Liu,Lan, AU - Li,Chenghao, AU - Huang,Yuan, AU - Jin,Haiyan, Y1 - 2018/09/24/ PY - 2018/06/11/received PY - 2018/09/07/accepted PY - 2018/9/27/pubmed PY - 2020/8/20/medline PY - 2018/9/26/entrez KW - Endoscopic retrograde cholangiopancreatography KW - Meta-analysis KW - Nonsteroidal anti-inflammatory drugs KW - Pancreatitis KW - Randomized controlled trials KW - Systematic review SP - 1991 EP - 2001 JF - Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract JO - J. Gastrointest. Surg. VL - 23 IS - 10 N2 - BACKGROUND OR PURPOSE: There is controversy regarding the efficacy of nonsteroidal anti-inflammatory drugs (NSAIDs) for prophylaxis against endoscopic retrograde cholangiopancreatography (ERCP) postoperative pancreatitis. Therefore, we conducted a systematic review and meta-analysis to evaluate the efficacy of NSAIDs for prophylaxis against post-ERCP pancreatitis (PEP). METHODS: PubMed, EMBASE, and Cochrane library databases were searched for relevant randomized controlled trials (RCTs). Selected RCTs were pooled under a fixed effects model to generate the relative risks (RRs) and their corresponding 95% confidence intervals (CIs). RESULTS: Nineteen RCTs involving a total of 5031 patients (2555 in the intervention group and 2476 in the control group) were selected. Overall, NSAIDs were associated with a significant reduction in risk of PEP (RR = 0.54, 95% CI 0.45 to 0.64, I2 = 40.4%) and moderate to severe PEP (RR = 0.45, 95% CI 0.30 to 0.67, I2 = 0%) compared with the control group. Subgroup analyses were performed according to route of administration (rectal or other), type of NSAIDs (diclofenac, indomethacin, or other), timing of administration (pre-ERCP, post-ERCP, or other), and patient population (high risk or general). Subgroup analyses showed difference in clinical efficacy of NSAID prophylaxis regardless of route, timing, or specific type of NSAID. CONCLUSION: NSAIDs were associated with a significant reduction in risk of PEP and moderate to severe PEP compared to the control group. SN - 1873-4626 UR - https://www.unboundmedicine.com/medline/citation/30251071/Nonsteroidal_Anti_inflammatory_Drugs_for_Endoscopic_Retrograde_Cholangiopancreatography_Postoperative_Pancreatitis_Prevention:_a_Systematic_Review_and_Meta_analysis_ L2 - https://dx.doi.org/10.1007/s11605-018-3967-7 DB - PRIME DP - Unbound Medicine ER -