Zheng Minghua, Bai Jianling, Yuan Bosi, Lin Feng, You Jie, Lu Mingqin, Gong Yuewen, Chen Yongping
Department of Infection and Liver Diseases, The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, China.
BMC Gastroenterol. 2008 Feb 14;8:6. doi: 10.1186/1471-230X-8-6.
Acute pancreatitis is a common complication of endoscopic retrograde cholangiopancreatography and benefit of pharmacological treatment is unclear. Although prophylactic use of corticosteroid for reduction of pancreatic injury after ERCP has been evaluated, discrepancy about beneficial effect of corticosteroid on pancreatic injury still exists. The aim of current study is to evaluate effectiveness and safety of corticosteroid in prophylaxis of post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP).
We employed the method recommended by the Cochrane Collaboration to perform a meta-analysis of seven randomized controlled trials (RCTs) of corticosteroid in prevention of post-ERCP pancreatitis (PEP) around the world.
Most of the seven RCTs were of high quality. When the RCTs were analyzed, odds ratios (OR) for corticosteroid were 1.13 [95% CI (0.891.44), p = 0.32] for PEP, 1.61 [95% CI (0.743.52), p = 0.23] for severe PEP, 0.92 [95% CI (0.57~1.48), p = 0.73] for post-ERCP hyperamylasemia respectively. The results indicated that there were no beneficial effects of corticosteroid on acute pancreatitis and hyperamylasemia. No evidence of publication bias was found.
Corticosteroids cannot prevent pancreatic injury after ERCP. Therefore, their use in the prophylaxis of PEP is not recommended.
急性胰腺炎是内镜逆行胰胆管造影术的常见并发症，药物治疗的益处尚不清楚。尽管已评估了预防性使用皮质类固醇以减少内镜逆行胰胆管造影术后的胰腺损伤，但关于皮质类固醇对胰腺损伤有益作用的差异仍然存在。本研究的目的是评估皮质类固醇预防内镜逆行胰胆管造影术后胰腺炎（PEP）的有效性和安全性。
我们采用Cochrane协作网推荐的方法，对全球七项关于皮质类固醇预防内镜逆行胰胆管造影术后胰腺炎（PEP）的随机对照试验（RCT）进行荟萃分析。
七项RCT中的大多数质量较高。对这些RCT进行分析时，皮质类固醇用于PEP的比值比（OR）为1.13 [95%可信区间（CI）（0.891.44），p = 0.32]，用于严重PEP的OR为1.61 [95% CI（0.743.52），p = 0.23]，用于内镜逆行胰胆管造影术后高淀粉酶血症的OR为0.92 [95% CI（0.57~1.48），p = 0.73]。结果表明，皮质类固醇对急性胰腺炎和高淀粉酶血症没有有益作用。未发现发表偏倚的证据。
皮质类固醇不能预防内镜逆行胰胆管造影术后的胰腺损伤。因此，不建议将其用于预防PEP。
