Sajid MS, Khawaja AH, Sayegh M, Singh KK, Philipose Z. Systematic review and meta-analysis on the prophylactic role of non-steroidal anti-inflammatory drugs to prevent post-endoscopic retrograde cholangiopancreatography pancreatitis. World J Gastrointest Endosc 2015; 7(19): 1341-1349 [PMID: 26722616 DOI: 10.4253/wjge.v7.i19.1341]
Corresponding Author of This Article
Muhammad S Sajid, Surgical Associate Specialist, Department of General, Endoscopic and Laparoscopic Colorectal Surgery, Western Sussex Hospitals NHS Foundation Trust Worthing Hospital Worthing, Lyndhurst Road, Washington Suite, North Wing, West Sussex BN11 2DH, United Kingdom. surgeon1wrh@hotmail.com
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Gastroenterology & Hepatology
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Systematic Reviews
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Sajid MS, Khawaja AH, Sayegh M, Singh KK, Philipose Z. Systematic review and meta-analysis on the prophylactic role of non-steroidal anti-inflammatory drugs to prevent post-endoscopic retrograde cholangiopancreatography pancreatitis. World J Gastrointest Endosc 2015; 7(19): 1341-1349 [PMID: 26722616 DOI: 10.4253/wjge.v7.i19.1341]
World J Gastrointest Endosc. Dec 25, 2015; 7(19): 1341-1349 Published online Dec 25, 2015. doi: 10.4253/wjge.v7.i19.1341
Systematic review and meta-analysis on the prophylactic role of non-steroidal anti-inflammatory drugs to prevent post-endoscopic retrograde cholangiopancreatography pancreatitis
Zinu Philipose, Krishna K Singh, Mazin Sayegh, Amir H Khawaja, Muhammad S Sajid
Muhammad S Sajid, Amir H Khawaja, Department of General, Endoscopic and Laparoscopic Colorectal Surgery, Western Sussex Hospitals NHS Foundation Trust Worthing Hospital Worthing, West Sussex BN11 2DH, United Kingdom
Mazin Sayegh, Krishna K Singh, Department of General, Upper Gastrointestinal and Hepato-pancreatico-biliary Surgery, Western Sussex Hospitals NHS Foundation Trust Worthing Hospital Worthing, West Sussex BN11 2DH, United Kingdom
Zinu Philipose, Department of Gastroenterology and Hepatology, Western Sussex Hospitals NHS Foundation Trust Worthing Hospital Worthing, West Sussex BN11 2DH, United Kingdom
Author contributions: Sajid MS, Sayegh M, Singh KK and Philipose Z contributed to study conception; Sajid MS, Khawaja AH and Philipose Z contributed to design; Sajid MS and Khawaja AH contributed to literature search, data analysis and drafting the article; Sajid MS, Khawaja AH, Sayegh M, Singh KK and Philipose Z contributed to PRISMA flow chart for study selection and data interpretation; Sajid MS and Khawaja AH contributed to data acquisition; Sajid MS, Khawaja AH and Philipose Z contributed to data confirmation; Sayegh M, Singh KK and Philipose Z contributed to proofreading of the article; all author final approval of the version to be published.
Conflict-of-interest statement: None to declare.
Data sharing statement: We confirm that all authors were involved with the data extraction, data related conflict resolution by mutual consensus and data securing. This data is the sole property of the listed authors and we did not share this data with any other research team and we did not duplicate this data in any other article.
Correspondence to: Muhammad S Sajid, Surgical Associate Specialist, Department of General, Endoscopic and Laparoscopic Colorectal Surgery, Western Sussex Hospitals NHS Foundation Trust Worthing Hospital Worthing, Lyndhurst Road, Washington Suite, North Wing, West Sussex BN11 2DH, United Kingdom. surgeon1wrh@hotmail.com
Received: June 9, 2015 Peer-review started: June 11, 2015 First decision: August 5, 2015 Revised: October 13, 2015 Accepted: November 10, 2015 Article in press: November 11, 2015 Published online: December 25, 2015 Processing time: 196 Days and 8.8 Hours
Abstract
AIM: To critically appraise the published randomized, controlled trials on the prophylactic effectiveness of the non-steroidal anti-inflammatory drugs (NSAIDs), in reducing the risk of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis.
METHODS: A systematic literature search (MEDLINE, Embase and the Cochrane Library, from inception of the databases until May 2015) was conducted to identify randomized, clinical trials investigating the role of NSAIDs in reducing the risk of post-ERCP pancreatitis. Random effects model of the meta-analysis was carried out, and results were presented as odds ratios (OR) with corresponding 95%CI.
RESULTS: Thirteen randomized controlled trials on 3378 patients were included in the final meta-analysis. There were 1718 patients in the NSAIDs group and 1660 patients in non-NSAIDs group undergoing ERCP. The use of NSAIDs (through rectal route or intramuscular route) was associated with the reduced risk of post-ERCP pancreatitis [OR, 0.52 (0.38-0.72), P = 0.0001]. The use of pre-procedure NSAIDs was effective in reducing approximately 48% incidence of post-ERCP pancreatitis, number needed to treat were 16 with absolute risk reduction of 0.05. But the risk of post-ERCP pancreattis was reduced by 55% if NSAIDs were administered after procedure. Similarly, diclofenac was more effective (55%) prophylactic agent compared to indomethacin (41%).
CONCLUSION: NSAIDs seem to have clinically proven advantage of reducing the risk of post-ERCP pancreatitis.
Core tip: Current meta-analysis of 13 randomized controlled trials on 3378 patients successfully demonstrates the usefulness of non-steroidal anti-inflammatory drugs (NSAIDs) in the prevention of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. Post-procedure use of NSAIDs by any route has clinically proven advantage of reducing 55% risk of post-ERCP pancreatitis. Diclofenac (55%) compared to indomethacin (41%) was more effective prophylactic agent.
