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The Incidence and Severity of Post-ERCP Pancreatitis in Patients Receiving Standard Administration of NSAIDs: a Systematic Review and Meta-analysis

  • Review Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Routine rectal administration of 100 mg of diclofenac or indomethacin was demonstrated to be an effective prevention method to prevent post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. The systematic review and meta-analysis aimed to estimate the incidence and severity of post-ERCP pancreatitis (PEP) and explore the discrepancies of PEP incidences among different subgroups.

Methods

The PubMed, Web of Science, and Ovid EMBASE databases were searched for studies published until December 2020. Only randomized controlled trials (RCTs) reported rectal administration of 100 mg or higher doses of diclofenac or indomethacin, with PEP as the primary outcomes were eligible for inclusion. The overall and severity of PEP were estimated. Subgroup analysis was performed based on geographic regions, risk level, study beginning time, type of NSAIDs, administration time, and sample size.

Results

There were 26 randomized controlled trials (RCTs) with 7954 patients in 31 NSAIDs arms. The pooled incidences were 7.2% for overall PEP (95% confidence interval (CI) 5.9–8.5%), 5.0% for mild PEP (95% CI, 4.0–6.0%), and 1.5% for moderate and severe PEP (0.8–2.3%). PEP rate were higher in patients receiving rectal indomethacin than that of patients receiving rectal diclofenac (7.8% (95% CI, 6.4–9.3%) vs 3.8% (95% CI, 2.2–5.3%), p = 0.009). The PEP rates of high-risk patients and average-risk patients were 8.9% (95% CI, 5.6–12.2%) and 6.4% (95% CI, 5.1–7.6%), respectively (p = 0.160).

Conclusions

The incidence of PEP was higher in patients receiving 100 mg rectal indomethacin than patients receiving 100 mg diclofenac. The effect of 100 mg diclofenac versus indomethacin on preventing PEP requires further study.

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Abbreviations

ERCP:

Endoscopic retrograde cholangiopancreatography

PEP:

Post-ERCP pancreatitis

NSAID:

Nonsteroidal anti-inflammatory drugs

ESGE:

European Society of Gastrointestinal Endoscopy

RCT:

Randomized controlled trial

CI:

Confidence interval

PD:

Pancreatic duct

RR:

Risk ratio

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Funding

This work was supported in part by the National Natural Science Foundation of China (81970557 and 82003152). The funding bodies were not involved in the design of this study, in the collection, analysis, and interpretation of the data, or in writing of the manuscript.

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Author notes

  1. Xiaoyu Kang and Xiaoyang Guo contributed equally to this work.

Authors and Affiliations

  1. State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, Shaanxi, People’s Republic of China

    Xiaoyu Kang, Xiaoyang Guo, Zhangqian Chen, Hui Luo, lijun Lou, Xuegang Guo & Yanglin Pan

  2. Department of Ultrasound, The 305 Hospital of PLA, Bejing, People’s Republic of China

    Xiaoyang Guo

  3. Department of Infectious Diseases, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, People’s Republic of China

    Zhangqian Chen

  4. Radiation Oncology Center, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China

    Zhirui Zhou

  5. Department of Oncology, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, People’s Republic of China

    Yajie Lu

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  1. Xiaoyu Kang
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Contributions

Conceptualization: Xiaoyu Kang, Yanglin Pan, Xuegang Guo. Data curation: Xiaoyang Guo, Zhangqian Chen, Hui Luo. Formal analysis: Lijun Lou. Methodology: Jieya Lu. Software: Zhirui Zhou. Writing—original draft: Xiaoyu Kang. Writing—review and editing: Yanglin Pan.

Corresponding author

Correspondence to Yanglin Pan.

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Ethics Approval

An ethical approval was not required for this meta-analysis after we consulted with our institutional ethical board of our hospital. So an ethical board approval statement was not included in this article.

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Kang, X., Guo, X., Chen, Z. et al. The Incidence and Severity of Post-ERCP Pancreatitis in Patients Receiving Standard Administration of NSAIDs: a Systematic Review and Meta-analysis. J Gastrointest Surg 26, 2380–2389 (2022). https://doi.org/10.1007/s11605-022-05399-6

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