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Nonsteroidal Anti-inflammatory Drugs for Endoscopic Retrograde Cholangiopancreatography Postoperative Pancreatitis Prevention: a Systematic Review and Meta-analysis

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background or Purpose

There is controversy regarding the efficacy of nonsteroidal anti-inflammatory drugs (NSAIDs) for prophylaxis against endoscopic retrograde cholangiopancreatography (ERCP) postoperative pancreatitis. Therefore, we conducted a systematic review and meta-analysis to evaluate the efficacy of NSAIDs for prophylaxis against post-ERCP pancreatitis (PEP).

Methods

PubMed, EMBASE, and Cochrane library databases were searched for relevant randomized controlled trials (RCTs). Selected RCTs were pooled under a fixed effects model to generate the relative risks (RRs) and their corresponding 95% confidence intervals (CIs).

Results

Nineteen RCTs involving a total of 5031 patients (2555 in the intervention group and 2476 in the control group) were selected. Overall, NSAIDs were associated with a significant reduction in risk of PEP (RR = 0.54, 95% CI 0.45 to 0.64, I2 = 40.4%) and moderate to severe PEP (RR = 0.45, 95% CI 0.30 to 0.67, I2 = 0%) compared with the control group. Subgroup analyses were performed according to route of administration (rectal or other), type of NSAIDs (diclofenac, indomethacin, or other), timing of administration (pre-ERCP, post-ERCP, or other), and patient population (high risk or general). Subgroup analyses showed difference in clinical efficacy of NSAID prophylaxis regardless of route, timing, or specific type of NSAID.

Conclusion

NSAIDs were associated with a significant reduction in risk of PEP and moderate to severe PEP compared to the control group.

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Funding

This study received a financial support from the National Natural Science Foundation of China (81560400) and Natural Science Research Foundation of Jilin Province for Sciences and Technology (20160101181JC).

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Author notes

  1. Lan Liu and Chenghao Li contributed equally to this work.

Authors and Affiliations

  1. Department of Pathology, Affiliated Hospital of Yanbian University, Yanji, 133000, China

    Lan Liu

  2. Department of Gastroenterology and Hepatology, Affiliated Hospital of Yanbian University, Yanji, 133000, China

    Chenghao Li, Yuan Huang & Haiyan Jin

Authors
  1. Lan Liu
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  2. Chenghao Li
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  3. Yuan Huang
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  4. Haiyan Jin
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Contributions

Lan Liu and Haiyan Jin conceived and supervised the study; Lan Liu, Chenghao Li, and Yuan Huang performed the research; Lan Liu and Chenghao Li analyzed and interpreted the data; Lan Liu and Haiyan Jin wrote the manuscript; Yuan Huang and Haiyan Jin made manuscript revisions. All authors reviewed the results and approved the final version of the manuscript.

Corresponding author

Correspondence to Haiyan Jin.

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The authors declare that they have no conflict of interest.

Electronic Supplementary Material

Figure S1

Filled funnel plot for PEP using Trim and Fill method. (PNG 45 kb)

High resolution image (TIF 178 kb)

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Liu, L., Li, C., Huang, Y. et al. Nonsteroidal Anti-inflammatory Drugs for Endoscopic Retrograde Cholangiopancreatography Postoperative Pancreatitis Prevention: a Systematic Review and Meta-analysis. J Gastrointest Surg 23, 1991–2001 (2019). https://doi.org/10.1007/s11605-018-3967-7

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  • DOI: https://doi.org/10.1007/s11605-018-3967-7

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