Department of Gastroenterology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an.
Department of Gastroenterology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China.
J Clin Gastroenterol. 2020 Apr;54(4):305-313. doi: 10.1097/MCG.0000000000001322.
Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is the most common complication of ERCP procedure. Nonsteroidal anti-inflammatory drugs (NSAIDs) are reported to be one protective pharmacological agent with great efficacy regarding this complication. Recently, more trails have addressed this issue and some inconsistent results appeared. Therefore, this study aims to evaluate the efficacy and safety of different rectal NSAIDs schemes to prevent PEP.
Eligible studies published on PubMed, the Cochrane Library, Embase, Web of Science before November 2018 were reviewed, and those which met the inclusion criteria were included in the analysis. The preventions were divided as placebo/no treatment, post-ERCP rectal diclofenac, pre-ERCP rectal diclofenac, post-ERCP rectal indomethacin, pre-ERCP rectal indomethacin, indomethacin using during ERCP, and pre-ERCP rectal naproxen. The main outcomes included the incidence of PEP and its severity. Other complications were also analyzed.
A total of 23 randomized controlled trials were included. The results of network meta-analysis illustrated that compared with the control, post-ERCP rectal diclofenac, pre-ERCP rectal diclofenac, and indomethacin were significantly associated with lower incidences of PEP. Moreover, it is notable that pre-ERCP rectal NSAIDs might reduce the severity of pancreatitis. Also, rectal NSAIDs may lead to less occurrence of asymptomatic hyperamylasemia. On the basis of the clustered ranking, pre-ERCP diclofenac appeared to be the superior intervention for PEP with satisfying efficacy.
The present study showed that pre-ERCP diclofenac is the optimal prevention method for PEP. However, more high quality head-to-head randomized controlled trials and observational studies are expected in the future.
内镜逆行胰胆管造影（ERCP）后胰腺炎（PEP）是 ERCP 术后最常见的并发症。非甾体抗炎药（NSAIDs）被报道为一种具有很好疗效的保护药理学药物，可预防这种并发症。最近，更多的试验已经解决了这个问题，但出现了一些不一致的结果。因此，本研究旨在评估不同直肠 NSAIDs 方案预防 PEP 的疗效和安全性。
对 2018 年 11 月前在 PubMed、Cochrane 图书馆、Embase、Web of Science 上发表的符合条件的研究进行了回顾，并将符合纳入标准的研究纳入分析。预防措施分为安慰剂/无治疗、ERCP 后直肠双氯芬酸、ERCP 前直肠双氯芬酸、ERCP 后直肠吲哚美辛、ERCP 前直肠吲哚美辛、ERCP 期间使用吲哚美辛和 ERCP 前直肠萘普生。主要结果包括 PEP 的发生率及其严重程度。还分析了其他并发症。
共纳入 23 项随机对照试验。网络荟萃分析结果表明，与对照组相比，ERCP 后直肠双氯芬酸、ERCP 前直肠双氯芬酸和吲哚美辛与 PEP 发生率降低显著相关。此外，值得注意的是，ERCP 前直肠 NSAIDs 可能降低胰腺炎的严重程度。此外，直肠 NSAIDs 可能导致无症状高淀粉酶血症的发生率降低。基于聚类排名，ERCP 前双氯芬酸似乎是预防 PEP 的最佳干预措施。
本研究表明，ERCP 前双氯芬酸是预防 PEP 的最佳方法。然而，未来有望开展更多高质量的头对头随机对照试验和观察性研究。
