Nitroglycerin in the Prevention of Post-ERCP Pancreatitis: A Meta-Analysis
- 218 Downloads
The objective of this research paper is to evaluate the effect of prophylactic nitroglycerin in the prevention of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) by performing a meta-analysis of randomized controlled trials (RCTs). Electronic databases, including PubMed, EMBASE, the Cochrane library, and the Science Citation Index, were searched to retrieve relevant trials. Outcome measures were the incidence of PEP. Four RCTs, enrolling a total of 856 patients, were included. Meta-analysis of these trials indicated a significant association between the use of nitroglycerin and the reduction of PEP (RR 0.60; 95%CI: 0.39–0.92; P = 0.02). However, subsequent sensitive analysis failed to confirm that nitroglycerin was statistically superior to a placebo in reducing PEP (RR 0.68; 95%CI: 0.41–1.11; P = 0.12). Based on the limitations in this meta-analysis, prophylactic use of nitroglycerine for all patients who underwent ERCP is not recommended. Further clinical trials are required to confirm the effect of nitroglycerin in the prevention of PEP.
KeywordsNitroglycerin Post-ERCP pancreatitis Meta-analysis
We are indebted to the authors of the primary studies.
- 16.Kaffes AJ, Bourke MJ, Ding S, Alrubaie A, Kwan V, Williams SJ. A prospective, randomized, placebo-controlled trial of transdermal glyceryl trinitrate in ERCP: effects on technical success and post-ERCP pancreatitis. Gastrointest Endosc. 2006;64:351–357. doi: 10.1016/j.gie.2005.11.060.CrossRefPubMedGoogle Scholar
- 21.Donnellan I, Hallissey M, Nwokolo C, Loft D, Fraser I. Sublingual GTN spray improves success at ERCP cannulation. Gut. 1994;35(Suppl 5):S36. (abstract).Google Scholar
- 25.Beauchant M, Ingrand P, Favriel JM, et al. Intravenous nitroglycerin for prevention of pancreatitis after therapeutic endoscopic retrograde cholangiography: a randomized, double-blind, placebo-controlled multicenter trial. Endoscopy. 2008;40:631–636. doi: 10.1055/s-2008-1077362.CrossRefPubMedGoogle Scholar