Journal of Gastroenterology

, Volume 49, Issue 3, pp 388–399

Pharmacologic prophylaxis of post-endoscopic retrograde cholangiopancreatography pancreatitis: protease inhibitors and NSAIDs in a meta-analysis

  • Hiroki Yuhara
  • Masami Ogawa
  • Yoshiaki Kawaguchi
  • Muneki Igarashi
  • Tooru Shimosegawa
  • Tetsuya Mine
Review

DOI: 10.1007/s00535-013-0834-x

Cite this article as:
Yuhara, H., Ogawa, M., Kawaguchi, Y. et al. J Gastroenterol (2014) 49: 388. doi:10.1007/s00535-013-0834-x

Abstract

Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis is the most frequent complication of ERCP. Several meta-analyses have examined the effects of protease inhibitors (gabexate mesilate, ulinastatin, and nafamostat mesilate) and non-steroidal anti-inflammatory drugs (NSAIDs) on post-ERCP pancreatitis, but the results have been confusing. Since the previous meta-analysis, several new studies have been published on this topic. To provide an updated quantitative assessment of the effectiveness of protease inhibitors and NSAIDs in preventing post-ERCP pancreatitis, we conducted a meta-analysis of randomized trials for patients at risk of post-ERCP pancreatitis. Twenty-six articles were included in this meta-analysis. Nafamostat mesilate (summary RR = 0.41; 95 %CI 0.28–0.59; n = 4 studies) and NSAIDs (summary RR = 0.58; 95 %CI = 0.44–0.76; n = 7 studies) were associated with decreased risk of post-ERCP pancreatitis in the high-quality studies. However, gabexate mesilate (summary RR = 0.64; 95 %CI = 0.36–1.13; n = 6 studies) and ulinastatin (summary RR = 0.65; 95 %CI = 0.33–1.30; n = 2 studies) were not associated with decreased risk of post-ERCP pancreatitis in the high-quality studies. This is the first meta-analysis to compare the effects of three protease inhibitors. Solid evidence supports the use of nafamostat mesilate and NSAIDs for preventing post-ERCP pancreatitis.

Keywords

Post-ERCP pancreatitisProtease inhibitorGabexate mesilateUlinastatinNafamostat mesilateNSAIDs

Copyright information

© Springer Japan 2013

Authors and Affiliations

  • Hiroki Yuhara
    • 1
  • Masami Ogawa
    • 1
  • Yoshiaki Kawaguchi
    • 1
  • Muneki Igarashi
    • 1
  • Tooru Shimosegawa
    • 2
  • Tetsuya Mine
    • 1
  1. 1.Department of GastroenterologyTokai University School of MedicineIseharaJapan
  2. 2.Division of GastroenterologyTohoku University Graduate School of MedicineSendaiJapan