Nonsteroidal anti-inflammatory drugs for prevention of post-ERCP pancreatitis: a meta-analysis

Background The use of nonsteroidal anti-inflammatory drugs (NSAIDs) in the prevention of post-ERCP pancreatitis (PEP) is still controversial. Objective We performed a meta-analysis to evaluate the efficacy and safety of NSAIDs for PEP prophylaxis. Design We systematically searched PubMed, EMBASE, We...

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Bibliographic Details
Published in:Gastrointestinal endoscopy 2012-12, Vol.76 (6), p.1152-1159
Main Authors: Ding, Xiwei, MD, Chen, Min, MD, Huang, Shuling, MD, Zhang, Song, MD, Zou, Xiaoping, MD
Format: Article
Language:English
Subjects:
Anti-Inflammatory Agents, Non-Steroidal - therapeutic use
Biological and medical sciences
Bones, joints and connective tissue. Antiinflammatory agents
Cholangiopancreatography, Endoscopic Retrograde - adverse effects
Digestive system
Gastroenterology and Hepatology
Gastroenterology. Liver. Pancreas. Abdomen
Humans
Incidence
Investigative techniques, diagnostic techniques (general aspects)
Liver. Biliary tract. Portal circulation. Exocrine pancreas
Medical sciences
Other diseases. Semiology
Pancreatitis - epidemiology
Pancreatitis - etiology
Pancreatitis - prevention & control
Pharmacology. Drug treatments
Radiodiagnosis. Nmr imagery. Nmr spectrometry
Treatment Outcome
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Summary:Background The use of nonsteroidal anti-inflammatory drugs (NSAIDs) in the prevention of post-ERCP pancreatitis (PEP) is still controversial. Objective We performed a meta-analysis to evaluate the efficacy and safety of NSAIDs for PEP prophylaxis. Design We systematically searched PubMed, EMBASE, Web of Science, and the Cochrane Library for relevant studies published updated to June 2012. Setting Meta-analysis. Patients Patients undergoing ERCP. Interventions NSAIDs use for the prevention of PEP. Main Outcome Measurements Overall incidence of PEP, incidence of moderate to severe PEP, and adverse events. Results Ten RCTs involving 2269 patients were included. Meta-analysis showed that NSAID use decreased the overall incidence of PEP (risk ratio [RR], 0.57; 95% CI, 0.38-0.86; P = .007). The absolute risk reduction was 5.9%. The number needed to treat was 17. Heterogeneity among the studies was substantial. However, after removing the main source of heterogeneity, the prophylactic efficacy was similar (RR, 0.53; 95% CI, 0.41-0.68; P < .001). NSAID use also decreased the incidence of moderate to severe PEP (RR 0.46; 95% CI, 0.28-0.75; P = .002). The absolute risk reduction was 3.0%. The number needed to treat was 34. No differences of the adverse events attributable to NSAIDs were observed. Limitations Inclusion of low-quality studies, different type and route of administration of the NSAIDs, study heterogeneity, inconsistent use of pancreatic stenting. Conclusions Prophylactic use of NSAIDs reduces the incidence and severity of PEP.
ISSN:0016-5107
1097-6779
DOI:10.1016/j.gie.2012.08.021