Hofstra Northwell School of Medicine, Northwell Health System, Long Island Jewish Medical Center, New Hyde Park, New York, USA.
Gastrointest Endosc. 2017 Jan;85(1):67-75. doi: 10.1016/j.gie.2016.08.034. Epub 2016 Sep 6.
Rectal indomethacin is a popular chemopreventive agent to help prevent post-ERCP pancreatitis (PEP). Previous meta-analyses have shown an overall protective effect for PEP in average-risk and high-risk patients. However, these meta-analyses are limited by a small number of studies. Recently, more trials have been published addressing this issue. The aim is to determine whether rectal indomethacin prevents PEP in average-risk and high-risk groups, after incorporating these new data.
A comprehensive search of multiple literature databases in April 2016 was performed. Human prospective randomized controlled trials with placebo controls that examined the effect of rectally administered indomethacin on the incidence of PEP were included.
A total of 8 trials between 2007 and 2016 (n = 3778) were included. No significant publication bias existed. All studies used similar criteria to detect pancreatitis. Random effects model meta-analysis showed that the rate of PEP was significantly lower using indomethacin compared with placebo (relative risk, 0.43; 95% confidence interval, 0.28-0.65; P < .001) in high-risk patients. There was no significant statistical or clinical heterogeneity. Among average-risk patients, the rate of PEP was similar (non-significant) between the indomethacin and placebo groups (relative risk, 0.74; 95% confidence interval, 0.52-1.07; P = .115). The result of the main outcome remained robust in multiple sensitivity analyses.
Rectal indomethacin given before or after ERCP is protective against PEP in high-risk patients versus placebo; however, it is not protective in average-risk patients versus placebo.
直肠用吲哚美辛是一种常用的化学预防剂，有助于预防内镜逆行胰胆管造影术（ERCP）后胰腺炎（PEP）。先前的荟萃分析显示，吲哚美辛对低危和高危患者的 PEP 均有总体保护作用。然而，这些荟萃分析受到研究数量较少的限制。最近，更多的试验已经发表，以解决这个问题。本研究旨在纳入这些新数据后，确定直肠用吲哚美辛是否可以预防低危和高危患者的 PEP。
2016 年 4 月，对多个文献数据库进行了全面检索。纳入了使用安慰剂对照、观察直肠给予吲哚美辛对 PEP 发生率影响的前瞻性随机对照试验。
共纳入 2007 年至 2016 年的 8 项研究（n=3778）。不存在显著的发表偏倚。所有研究均采用相似的标准来检测胰腺炎。随机效应模型荟萃分析显示，在高危患者中，吲哚美辛组 PEP 的发生率明显低于安慰剂组（相对风险，0.43；95%置信区间，0.28-0.65；P<0.001）。无明显的统计学或临床异质性。在低危患者中，吲哚美辛组和安慰剂组的 PEP 发生率相似（无统计学意义）（相对风险，0.74；95%置信区间，0.52-1.07；P=0.115）。主要结局的结果在多次敏感性分析中仍然稳健。
ERCP 前后给予直肠用吲哚美辛可预防高危患者的 PEP，但对低危患者与安慰剂相比无预防作用。
