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.
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.
Authors: Vilja Koskensalo; Andrea Tenca; Marianne Udd; Outi Lindström; Mia Rainio; Kalle Jokelainen; Leena Kylänpää; Martti Färkkilä Journal: United European Gastroenterol J Date: 2020-03-08 Impact factor: 4.623