Meta-Analysis
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World J Gastroenterol. Sep 14, 2014; 20(34): 12322-12329
Published online Sep 14, 2014. doi: 10.3748/wjg.v20.i34.12322
Effectiveness of nonsteroidal anti-inflammatory drugs in prevention of post-ERCP pancreatitis: A meta-analysis
Xiao Li, Li-Ping Tao, Chun-Hui Wang
Xiao Li, Li-Ping Tao, Chun-Hui Wang, Department of Gastroenterology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Wang CH and Li X designed the study; Tao LP and Li X analyzed the available data and assessed the quality of each study in accordance with pre-determined criteria; Li X performed the literature search and wrote the manuscript; all authors have read and approved the final manuscript.
Correspondence to: Chun-Hui Wang, MD, Department of Gastroenterology, West China Hospital of Sichuan University, No. 37 Guoxuexiang, Wuhou District, Chengdu 610041, Sichuan Province, China. dwangsc@sina.com
Telephone: +86-28-85422385 Fax: +86-28-85422385
Received: January 19, 2014
Revised: March 10, 2014
Accepted: April 30, 2014
Published online: September 14, 2014
Processing time: 241 Days and 23.3 Hours
Abstract

AIM: To investigate the effect of nonsteroidal anti-inflammatory drugs (NSAIDs) on the incidence of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP).

METHODS: Two independent reviewers searched PubMed (1966 to October 2013), Embase (1984 to October 2013) and the Cochrane Central Register of Controlled Trials (CENTRAL; Issue 4, 2013) for relevant randomized controlled trials (RCTs) studying the effectiveness of prophylactic NSAID administration in the prevention of PEP. Using the Cochrane Collaboration Handbook, meta-analyses were conducted to evaluate the overall effect of NSAIDs in preventing the incidences of PEP and moderate to severe pancreatitis.

RESULTS: Eight RCTs were identified from the literature search and included 1883 patients that underwent ERCP, with 971 patients in the NSAID group and 912 patients in the placebo group. Sixty-nine out of 971 (7.11%) patients developed PEP in the NSAID group in comparison to 143 out of 912 (15.68%) patients in the placebo group. The pooled RR of PEP incidence with prophylactic NSAID administration was 0.43 (95%CI: 0.33-0.56), which demonstrates that NSAID administration after ERCP significantly reduced the incidence of PEP when compared to the placebo group (P < 0.0001). Subgroup analysis was performed and revealed that the presence (NSAID group) or absence (placebo group) of NSAIDs had no significant effect on the development of moderate to severe pancreatitis (RR = 0.79, 95%CI: 0.52-1.18). Moreover, the administration of NSAIDs as a rectal suppository (RR = 0.35, 95%CI: 0.26-0.48; P < 0.0001) was more effective than oral administration (RR = 0.97, 95%CI: 0.53-1.80) or through infusion (RR = 0.43, 95%CI: 0.12-1.54).

CONCLUSION: NSAIDs effectively reduce the incidence of PEP but not of moderate to severe pancreatitis.

Keywords: Nonsteroidal anti-inflammatory drugs; Post-endoscopic retrograde cholangiopancreatography pancreatitis; Randomized controlled trial; Meta-analysis

Core tip: This meta-analysis was designed to compare the incidence of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) in the presence or absence of prophylactic nonsteroidal anti-inflammatory drug (NSAID) administration after ERCP. A total of eight studies were included in the pooled analysis and contained 1883 patients that underwent ERCP with 971 patients in the NSAID group and 912 patients in the control group. Patients receiving NSAIDs after ERCP had a reduced incidence of PEP when compared with the placebo group, though NSAID administration did not reduce the incidence of moderate to severe pancreatitis.