Department of Pathology, Affiliated Hospital of Yanbian University, Yanji, 133000, China.
Department of Gastroenterology and Hepatology, Affiliated Hospital of Yanbian University, Yanji, 133000, China.
J Gastrointest Surg. 2019 Oct;23(10):1991-2001. doi: 10.1007/s11605-018-3967-7. Epub 2018 Sep 24.
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).
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).
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, I = 40.4%) and moderate to severe PEP (RR = 0.45, 95% CI 0.30 to 0.67, I = 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.
NSAIDs were associated with a significant reduction in risk of PEP and moderate to severe PEP compared to the control group.
对于非甾体抗炎药（NSAIDs）预防内镜逆行胰胆管造影（ERCP）术后胰腺炎（PEP）的疗效存在争议。因此，我们进行了系统评价和荟萃分析，以评估 NSAIDs 预防 ERCP 术后胰腺炎（PEP）的疗效。
检索了 PubMed、EMBASE 和 Cochrane 图书馆数据库，以获取相关的随机对照试验（RCT）。选择的 RCT 采用固定效应模型进行汇总，以生成相对风险（RR）及其相应的 95%置信区间（CI）。
共纳入了 19 项 RCT，涉及 5031 例患者（干预组 2555 例，对照组 2476 例）。总体而言，与对照组相比，NSAIDs 可显著降低 PEP（RR=0.54，95%CI 0.45 至 0.64，I²=40.4%）和中重度 PEP（RR=0.45，95%CI 0.30 至 0.67，I²=0%）的风险。根据给药途径（直肠或其他）、NSAIDs 类型（双氯芬酸、吲哚美辛或其他）、给药时间（ERCP 前、ERCP 后或其他）和患者人群（高危或一般）进行了亚组分析。亚组分析显示，无论给药途径、时间或 NSAID 的具体类型如何，NSAID 预防的临床疗效均存在差异。
与对照组相比，NSAIDs 可显著降低 PEP 和中重度 PEP 的风险。
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