Fei Du1,2, Yongxuan Zhang1,2, Xiaozhou Yang1,2, Lingkai Zhang1,2, Wencong Yuan1,2, Haining Fan2,3, Li Ren4,5. 1. Department of Hepatobiliary-Pancreatic Surgery, Affiliated Hospital of Qinghai University, Xining, 810000, China. 2. Graduate School of Qinghai University, Xining, 810000, China. 3. Qinghai Key Laboratory of Echinococcosis Research, Xining, 810000, China. 4. Graduate School of Qinghai University, Xining, 810000, China. renli_xn@163.com. 5. Qinghai Key Laboratory of Echinococcosis Research, Xining, 810000, China. renli_xn@163.com.
Abstract
OBJECTIVES: To systematically evaluate the clinical efficacy of rectal nonsteroidal anti-inflammatory drugs (NSAIDs) alone or in combination with other agents for preventing pancreatitis after endoscopic retrograde cholangiopanography. METHODS: We carried out a literature search of random controlled trials (RCTs) on preventing post-operative pancreatitis by administration of the anti-inflammatory drugs, indomethacin and diclofenac, following endoscopic retrograde cholangiopancreatography (ERCP). The databases searched for relevant publications up to July 7, 2021, included PubMed, Cochrane Library, and Embase. We screened the literature according to inclusion criteria and analyzed the extracted data. The overall population and high-risk patient groups were analyzed, with the main outcome being the incidence of PEP. RESULTS: The search identified 32 RCTs that included 15019 patients with post-ERCP pancreatitis and 9 different interventions. The results of the overall population network meta-analysis showed that NSAIDs alone, high-dose NSAIDs, and a combination of NSAIDs significantly reduced the incidence of PEP compared with placebo. However, compared with placebo, there was no statistically significant difference between the two interventions (NSAIDs + standard hydration and high-dose NSAIDs). In addition, NSAIDs + sublingual nitrates were associated with a lower incidence of PEP compared to that observed with NSAIDs alone. Probability ranking results showed that NSAIDs + sublingual nitrate had the best effect, followed by NSAIDs + standard hydration, NSAIDs + melatonin, NSAIDs + aggressive hydration, NSAIDs + somatostatin, NSAIDs alone, NSAIDs + epinephrine, high-dose NSAIDs, and placebo. In the high-risk subgroup, the results of the network meta-analysis showed that NSAIDs alone, high-dose NSAIDs, and a combination of NSAIDs showed no statistically significant difference in their ability to reduce the incidence of PEP compared with placebo. Probability ranking results showed that NSAIDs + hydration had the best effect, followed by NSAIDs + sublingual nitroglycerin and NSAIDs + aggressive hydration. CONCLUSION: Of the nine interventions, NSAIDs + sublingual nitrates had considerably better efficacy than the other drugs for reducing the incidence of PEP in the overall population. In high-risk patients, NSAIDs + standard hydration may be the best preventive treatment; however, more randomized, controlled trials are needed to validate our results. TRIAL REGISTRATION: Name of the registry: PROSPERO-International prospective register of systematic reviews. Unique identifying number or registration ID: CRD42021282205.
OBJECTIVES: To systematically evaluate the clinical efficacy of rectal nonsteroidal anti-inflammatory drugs (NSAIDs) alone or in combination with other agents for preventing pancreatitis after endoscopic retrograde cholangiopanography. METHODS: We carried out a literature search of random controlled trials (RCTs) on preventing post-operative pancreatitis by administration of the anti-inflammatory drugs, indomethacin and diclofenac, following endoscopic retrograde cholangiopancreatography (ERCP). The databases searched for relevant publications up to July 7, 2021, included PubMed, Cochrane Library, and Embase. We screened the literature according to inclusion criteria and analyzed the extracted data. The overall population and high-risk patient groups were analyzed, with the main outcome being the incidence of PEP. RESULTS: The search identified 32 RCTs that included 15019 patients with post-ERCP pancreatitis and 9 different interventions. The results of the overall population network meta-analysis showed that NSAIDs alone, high-dose NSAIDs, and a combination of NSAIDs significantly reduced the incidence of PEP compared with placebo. However, compared with placebo, there was no statistically significant difference between the two interventions (NSAIDs + standard hydration and high-dose NSAIDs). In addition, NSAIDs + sublingual nitrates were associated with a lower incidence of PEP compared to that observed with NSAIDs alone. Probability ranking results showed that NSAIDs + sublingual nitrate had the best effect, followed by NSAIDs + standard hydration, NSAIDs + melatonin, NSAIDs + aggressive hydration, NSAIDs + somatostatin, NSAIDs alone, NSAIDs + epinephrine, high-dose NSAIDs, and placebo. In the high-risk subgroup, the results of the network meta-analysis showed that NSAIDs alone, high-dose NSAIDs, and a combination of NSAIDs showed no statistically significant difference in their ability to reduce the incidence of PEP compared with placebo. Probability ranking results showed that NSAIDs + hydration had the best effect, followed by NSAIDs + sublingual nitroglycerin and NSAIDs + aggressive hydration. CONCLUSION: Of the nine interventions, NSAIDs + sublingual nitrates had considerably better efficacy than the other drugs for reducing the incidence of PEP in the overall population. In high-risk patients, NSAIDs + standard hydration may be the best preventive treatment; however, more randomized, controlled trials are needed to validate our results. TRIAL REGISTRATION: Name of the registry: PROSPERO-International prospective register of systematic reviews. Unique identifying number or registration ID: CRD42021282205.
Authors: P B Cotton; G Lehman; J Vennes; J E Geenen; R C Russell; W C Meyers; C Liguory; N Nickl Journal: Gastrointest Endosc Date: 1991 May-Jun Impact factor: 9.427
Authors: Jean-Marc Dumonceau; Christine Kapral; Lars Aabakken; Ioannis S Papanikolaou; Andrea Tringali; Geoffroy Vanbiervliet; Torsten Beyna; Mario Dinis-Ribeiro; Istvan Hritz; Alberto Mariani; Gregorios Paspatis; Franco Radaelli; Sundeep Lakhtakia; Andrew M Veitch; Jeanin E van Hooft Journal: Endoscopy Date: 2019-12-20 Impact factor: 10.093
Authors: Christina J Sperna Weiland; Xavier J N M Smeets; Wietske Kievit; Robert C Verdonk; Alexander C Poen; Abha Bhalla; Niels G Venneman; Ben J M Witteman; David W da Costa; Brechje C van Eijck; Matthijs P Schwartz; Tessa E H Römkens; Jan Maarten Vrolijk; Muhammed Hadithi; Annet M C J Voorburg; Lubbertus C Baak; Willem J Thijs; Roy L van Wanrooij; Adriaan C I T L Tan; Tom C J Seerden; Yolande C A Keulemans; Thomas R de Wijkerslooth; Wim van de Vrie; Peter van der Schaar; Sven M van Dijk; Nora D L Hallensleben; Ruud L Sperna Weiland; Hester C Timmerhuis; Devica S Umans; Jeanin E van Hooft; Harry van Goor; Hjalmar C van Santvoort; Marc G Besselink; Marco J Bruno; Paul Fockens; Joost P H Drenth; Erwin J M van Geenen Journal: Lancet Gastroenterol Hepatol Date: 2021-03-19
Authors: Bharati Kochar; Venkata S Akshintala; Elham Afghani; B Joseph Elmunzer; Katherine J Kim; Anne Marie Lennon; Mouen A Khashab; Anthony N Kalloo; Vikesh K Singh Journal: Gastrointest Endosc Date: 2014-08-01 Impact factor: 9.427
Authors: Brian Hutton; Georgia Salanti; Deborah M Caldwell; Anna Chaimani; Christopher H Schmid; Chris Cameron; John P A Ioannidis; Sharon Straus; Kristian Thorlund; Jeroen P Jansen; Cynthia Mulrow; Ferrán Catalá-López; Peter C Gøtzsche; Kay Dickersin; Isabelle Boutron; Douglas G Altman; David Moher Journal: Ann Intern Med Date: 2015-06-02 Impact factor: 25.391
Authors: Juan Pablo Román Serrano; Diogo Turiani Hourneaux de Moura; Wanderley Marques Bernardo; Igor Braga Ribeiro; Tomazo Prince Franzini; Eduardo Turiani Hourneaux de Moura; Vitor Ottoboni Brunaldi; Marianne Torrezan Salesse; Paulo Sakai; Eduardo Guimarães Hourneaux De Moura Journal: Endosc Int Open Date: 2019-04-02