Efficacy of indomethacin for the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis: A comprehensive meta-analysis of randomized controlled trials

Abstract

BACKGROUND

Post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) is a prevalent and potentially serious complication in patients undergoing endoscopic retrograde cholangiopancreatography.

AIM

To comprehensively assess the efficacy of indomethacin therapy in reducing PEP risk.

METHODS

We searched PubMed, EMBASE, Scopus, and Cochrane Library databases to identify randomized controlled trials (RCTs) that compared rectal indomethacin with a control group to prevent PEP. Duplicates were removed, and studies were included based on the established inclusion criteria. We used the Cochrane Collaboration’s tool to assess the risk of bias in the RCTs. A random-effects model was applied to produce pooled risk ratios (RRs) with 95% confidence intervals (CIs).

RESULTS

We included a total of 30 RCTs involving 16977 patients. Compared to the control group, rectal indomethacin showed comparable rates of overall PEP (PEP; RR = 0.85, 95%CI: 0.69-1.04, I² = 79%) with no statistically significant difference of RR in mild (RR = 0.92, 95%CI: 0.74-1.14), moderate (RR = 0.78, 95%CI: 0.59-1.02), or severe PEP (RR = 1.12, 95%CI: 0.75-1.67). There was also no difference in cases of adverse events (RR = 0.97, 95%CI: 0.69-1.35), abdominal pain (RR = 1.14, 95%CI: 0.80-1.62), bleeding (RR = 1.07, 95%CI: 0.70-1.63), or mortality (RR = 0.86, 95%CI: 0.56-1.33) between the two groups. Subgroup analyses were also performed.

CONCLUSION

Rectal indomethacin appears to be safe and may offer benefit in selected high-risk patients, though findings should be interpreted with caution due to high heterogeneity.

Keywords: Post-endoscopic retrograde cholangiopancreatography pancreatitis; Indomethacin; Pancreatitis prevention; Prophylaxis; Meta-analysis

Core Tip: This meta-analysis assessed the efficacy of rectal indomethacin in the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis by reviewing the results of 30 randomized controlled trials. Indomethacin didn’t show a significant reduction in overall post-endoscopic retrograde cholangiopancreatography pancreatitis rates or adverse events relative to controls, however, it may be beneficial in particular high-risk patients, but with caution given to significant heterogeneity in the results.