Department of Internal Medicine, University of Toledo Medical Center, 3000 Arlington Ave, Toledo, OH, 43614, United States.
Department of Gastroenterology, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin St, Houston, TX, 77030, United States.
Pancreatology. 2020 Apr;20(3):356-361. doi: 10.1016/j.pan.2020.02.003. Epub 2020 Feb 19.
Recent studies have compared the utility of rectal indomethacin with topical epinephrine (IE) sprayed on duodenal papilla and rectal indomethacin alone (IS) to prevent post-ERCP pancreatitis (PEP) with conflicting results. We performed a systematic review and meta-analysis to evaluate the benefit of using the combination prophylaxis as oppose to rectal indomethacin alone.
The following database were searched for our systematic review: PubMed∖Medline, Embase, Cochrane, and Web of Science. We included both randomized controlled trials (RCTs) and cohort studies. Primary outcome was incidence of PEP and secondary outcomes were adverse events and mortality.
A total of 3 studies (all RCTs) with 2244 patients (1132 in IS and 1112 in IE group) were included. The IE group did not demonstrate any significant benefit over IS group in preventing PEP (RR: 1.15, 95% CI 0.62-2.2), mortality (RR: 0.85, 95% CI 0.22-3.24) or overall adverse events (RR: 1.3, 95% CI 0.93-1.7).
The combination of rectal indomethacin and topical epinephrine failed to demonstrate any benefit over indomethacin alone in preventing PEP, decreasing mortality and overall adverse events.
最近的研究比较了直肠吲哚美辛与喷洒在十二指肠乳头的局部肾上腺素（IE）以及单独使用直肠吲哚美辛（IS）预防内镜逆行胰胆管造影术后胰腺炎（PEP）的效果，结果存在争议。我们进行了一项系统评价和荟萃分析，以评估联合预防与单独使用直肠吲哚美辛的益处。
我们对以下数据库进行了系统检索：PubMed∖Medline、Embase、Cochrane 和 Web of Science。我们纳入了随机对照试验（RCT）和队列研究。主要结局是 PEP 的发生率，次要结局是不良事件和死亡率。
共有 3 项研究（均为 RCT）纳入了 2244 名患者（IS 组 1132 名，IE 组 1112 名）。IE 组在预防 PEP（RR：1.15，95%CI 0.62-2.2）、死亡率（RR：0.85，95%CI 0.22-3.24）或总体不良事件（RR：1.3，95%CI 0.93-1.7）方面均未显示出比 IS 组更显著的优势。
直肠吲哚美辛联合局部肾上腺素在预防 PEP、降低死亡率和总体不良事件方面并未显示出优于单独使用吲哚美辛的优势。
