Lyu Yunxiao, Wang Bin, Cheng Yunxiao, Xu Yueming, Du Weibing
Department of Hepatobiliary Surgery, Dongyang People's Hospital, Dongyang, Zhejiang, China.
Surg Laparosc Endosc Percutan Tech. 2019 Dec;29(6):426-432. doi: 10.1097/SLE.0000000000000707.
Postendoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is one of the most common complications after ERCP. The optimal drugs for reducing the risk of PEP are still unclear. This study aimed to compare the efficacy of 9 major drugs used worldwide for the prevention of PEP through a network meta-analysis.
We conducted a systematic search of the literature up to October 2018 on PubMed, Embase, Web of Science, the Cochrane Central Library, and ClinicalTrials.gov. Randomized controlled trials (RCTs) comparing allopurinol, diclofenac, gabexate (GAB), glyceryl trinitrate (GTN), indomethacin, nafamostat, octreotide, somatostatin, and ulinastatin for protection against PEP were included.
Eighty-six randomized controlled trials involving 25,246 patients were included in this network meta-analysis. Results indicated that diclofenac, GAB, GTN, indomethacin, somatostatin, and ulinastatin were more effective than placebo with odds ratios ranging between 0.48 (95% credible interval, 0.26-0.86) for GAB and 0.61 (0.39-0.94) for somatostatin. However, allopurinol, nafamostat, and octreotide showed similar efficacy as placebo in reducing the risk of PEP. No significant differences were found in the efficacy between diclofenac, GAB, GTN, indomethacin, somatostatin, and ulinastatin. In terms of prognosis, GAB may be the most effective treatment (surface under the cumulative ranking curve=70.6%) and the least effective was octreotide (surface under the cumulative ranking curve=28%).
Although our analysis suggests that GAB may be the most effective drug in preventing PEP, the limitations of our study warrants more high-quality head-to-head trials of these clinical drugs in the future.
内镜逆行胰胆管造影术（ERCP）后胰腺炎（PEP）是ERCP术后最常见的并发症之一。降低PEP风险的最佳药物仍不明确。本研究旨在通过网状Meta分析比较全球使用的9种主要药物预防PEP的疗效。
我们在PubMed、Embase、Web of Science、Cochrane中央图书馆和ClinicalTrials.gov上对截至2018年10月的文献进行了系统检索。纳入了比较别嘌醇、双氯芬酸、加贝酯（GAB）、硝酸甘油（GTN）、吲哚美辛、那法莫司他、奥曲肽、生长抑素和乌司他丁预防PEP的随机对照试验（RCT）。
本网状Meta分析纳入了86项涉及25246例患者的随机对照试验。结果表明，双氯芬酸、GAB、GTN、吲哚美辛、生长抑素和乌司他丁比安慰剂更有效，GAB的比值比为0.48（95%可信区间，0.26 - 0.86），生长抑素为0.61（0.39 - 0.94）。然而，别嘌醇、那法莫司他和奥曲肽在降低PEP风险方面与安慰剂疗效相似。双氯芬酸、GAB、GTN、吲哚美辛、生长抑素和乌司他丁之间的疗效无显著差异。在预后方面，GAB可能是最有效的治疗方法（累积排序曲线下面积 = 70.6%），最无效的是奥曲肽（累积排序曲线下面积 = 28%）。
虽然我们的分析表明GAB可能是预防PEP最有效的药物，但我们研究的局限性需要未来对这些临床药物进行更多高质量的直接比较试验。
