Systematic review and meta-analysisIndomethacin and diclofenac in the prevention of post-ERCP pancreatitis: a systematic review and meta-analysis of prospective controlled trials
Introduction
One of the greatest challenges for endoscopists performing ERCP is to decrease the frequency of post-ERCP pancreatitis (PEP). Since 1978, several basic studies and clinical recommendations have dealt with pharmacologic agents in the prevention of PEP. Diclofenac and indomethacin seem to be the most promising drugs for preventing PEP1, 2, 3, 4, 5, 6, 7, 8; nevertheless, a comprehensive consensus has not emerged with regard to their efficacy. The results of trials with too few patients9 differ; therefore a multicenter, carefully planned prospective, randomized, double-blind trial or meta-analysis with a sufficient number of patients can resolve this contradiction. In the absence of such original works, we have collected all prospective trials studying the efficacy of diclofenac or indomethacin for all routes of administration controlled with placebo or non-treatment for the prevention of PEP in adult patients undergoing ERCP.
Section snippets
Protocol and registration
This study was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.10 The review protocol is registered at the International Prospective Register of Systematic Reviews (PROSPERO), which can be accessed at http://www.crd.york.ac.uk/prospero/ under registration number CRD42016042726.
Eligibility criteria
Studies were included if they were prospective, controlled studies published in full text irrespective of language or publication status.
Information sources and search strategy
Study selection
A total of 540 publications were found using the search strategy outlined earlier (Fig. 1). After excluding duplicates (n = 352), 188 publications were screened by title and abstract. After thorough review, an additional 167 records were excluded, resulting in the full text of 21 publications to be assessed for eligibility. Four studies15, 16, 17, 18 were excluded: 2 were retrospective and in 2 trials the allocation to the placebo or non-treated and to the treated groups was not clearly
Discussion
The intention to improve the success rate of ERCP to over 90% goes hand in hand with a high adverse event rate that casts shadows on its excellent results.19, 38 All-cause mortality at 30 days is 5.3% in unselected patients,39 and therapeutic ERCP-specific mortality occurs in between 0.4% and 0.5% of patients.40, 41 The most common adverse event of ERCP is PEP40, 41 with an estimated rate of between 1.6% and 15.7%.42 In a recent meta-analysis including 13,296 patients, the PEP rate was 9.7%
Acknowledgments
The authors would like to thank Dr Eliane Coffler and Dr Andrea Fekete for their help with linguistic review.
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2023, Gastrointestinal EndoscopyPrior Exposure to Nonsteroidal Anti-inflammatory Drugs Reduces the Rate of Organ Failure and In-Hospital Mortality in Acute Pancreatitis
2022, American Journal of MedicineCitation Excerpt :Because the study by Huang et al9 was underpowered to establish differences in these outcomes, the only remaining available background to justify these possible immediate effects comes from the post-ERCP pancreatitis prevention literature. When administered within 1 hour of the procedure, NSAIDs are effective at preventing acute pancreatitis;24-26 confirming that they exert immediate anti-inflammatory effects that prevent it. Similar immediate effects were seen in the present study.
Rectal indometacin to prevent pancreatitis after extracorporeal shock wave lithotripsy (RIPEP): a single-centre, double-blind, randomised, placebo-controlled trial
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DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.
See CME section; p. 1284.
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