Organ Transplantation Center, Hospital of the University of Electronic Science and Technology of China and Sichuan Provincial People's Hospital, Chengdu 610072, Sichuan, PR China.
Department of Health Education, Chengdu Centers for Diseases Control and Prevention, Chengdu 610041, Sichuan, PR China.
Pancreatology. 2017 Sep-Oct;17(5):681-688. doi: 10.1016/j.pan.2017.07.008. Epub 2017 Jul 17.
Acute pancreatitis is one of the most common complications of endoscopic retrograde cholangiopancreatography (ERCP). Whether the prophylactic administration of rectal non-steroidal anti-inflammatory drugs (NSAIDs) peri-ERCP is effective in preventing post-ERCP pancreatitis (PEP) remains controversial. The aim of this study was to assess the effect of rectal NSAIDs on PEP.
A systematic search of literature databases (Cochrane Library, PubMed, EMBASE, and Web of Science) was performed to identify eligible randomized controlled trials (RCTs). The Jadad score for assessing risk of bias was used to evaluate the quality of included studies. The primary endpoint of the study was efficacy for PEP prevention. Sub-analyses were performed to determine the risk reduction for different NSAID types, for general vs. high-risk patients, by timing of administration and for moderate to severe PEP.
Twelve RCTs, including a total of 3989 patients, were identified and included in the analysis. The risk of PEP was lower in the NSAIDs group than in the placebo group (RR 0.52; 95% CI 0.43-0.64; P < 0.01). The risk of moderate to severe PEP was also lower in the NSAIDs group. (RR 0.44; 95% CI 0.28-0.69; P < 0.01). There was no difference in efficacy between rectal indomethacin and diclofenac, nor between pre-ERCP and post-ERCP administration timing of rectal NSAIDs.
A single rectal dose of NSAIDs is effective in preventing PEP both in high-risk and in unselected patients, regardless of timing of administration (pre- or post-ERCP) and NSAID type (indomethacin or diclofenac).
急性胰腺炎是内镜逆行胰胆管造影术（ERCP）最常见的并发症之一。在 ERCP 术前直肠给予非甾体抗炎药（NSAIDs）是否能有效预防 ERCP 后胰腺炎（PEP）仍存在争议。本研究旨在评估直肠 NSAIDs 对 PEP 的影响。
系统检索文献数据库（Cochrane 图书馆、PubMed、EMBASE 和 Web of Science），以确定合格的随机对照试验（RCTs）。采用 Jadad 评分评估纳入研究的质量。本研究的主要终点是预防 PEP 的疗效。进行了亚分析，以确定不同 NSAID 类型、一般风险与高风险患者、给药时间和中重度 PEP 的风险降低情况。
共确定了 12 项 RCTs，共纳入 3989 例患者。与安慰剂组相比，NSAIDs 组 PEP 的风险较低（RR 0.52；95% CI 0.43-0.64；P<0.01）。NSAIDs 组中中重度 PEP 的风险也较低（RR 0.44；95% CI 0.28-0.69；P<0.01）。直肠吲哚美辛和双氯芬酸的疗效无差异，ERCP 前和 ERCP 后直肠 NSAIDs 给药时间的疗效也无差异。
单次直肠给予 NSAIDs 可有效预防高危和非高危患者的 PEP，无论给药时间（ERCP 前或 ERCP 后）和 NSAID 类型（吲哚美辛或双氯芬酸）如何。
