Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan, ROC.
Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan, ROC; Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan, ROC; Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan, ROC; Research Center of Big Data and Meta-analysis Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan, ROC; Institute of Health Policy & Management, College of Public Health, National Taiwan University Taipei, Taiwan, ROC.
J Formos Med Assoc. 2021 Apr;120(4):1090-1099. doi: 10.1016/j.jfma.2020.10.034. Epub 2020 Nov 9.
BACKGROUND/PURPOSE: The evidence provided by syntheses of the preventative effects of gabexate mesilate against pancreatitis among patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) is limited and highly heterogeneous. To enhance the understanding of this topic, this study aimed to provide overview of gabexate mesilate on preventing post ERCP pancreatitis (PEP) by synthesizing all relevant randomized controlled trials (RCTs).
We searched three databases for relevant RCTs. Two authors independently extracted data of pancreatitis incidence after ERCP, abdominal pain within 48 hours, and hyperamylasemia for quality assessment and meta-analysis.
Thirteen RCTs with 3718 patients undergoing ERCP met the eligibility criteria and were included. The results revealed that the use of gabexate mesilate led to lower PEP (Peto odds ratio: 0.66, 95% confidence interval [CI]: 0.49 to 0.89), especially in the subgroup of gabexate mesilate infusion starting more than 30 min (Risk ratio: 0.45, 95% CI: 0.29 to 0.72).
The present synthesis found that gabexate mesilate could be an option of prophylactic treatment of pancreatitis for patients undergoing ERCP, and reveals that it is favorable to administer it starting 30 min before the ERCP. This evidence may improve the clinical prevention of PEP.
背景/目的：荟萃分析显示，甲磺酸加贝酯预防内镜逆行胰胆管造影术（ERCP）术后胰腺炎（PEP）的疗效证据有限且高度异质性。为了更深入地了解这一问题，本研究旨在通过汇总所有相关的随机对照试验（RCT）来概述甲磺酸加贝酯预防 ERCP 后胰腺炎（PEP）的作用。
我们在三个数据库中检索了相关的 RCT。两位作者独立提取了 ERCP 术后胰腺炎发生率、48 小时内腹痛和高淀粉酶血症的数据，用于质量评估和荟萃分析。
符合纳入标准的 13 项 RCT 共纳入 3718 例接受 ERCP 的患者。结果显示，使用甲磺酸加贝酯可降低 PEP 的发生率（Peto 优势比：0.66，95%置信区间 [CI]：0.49 至 0.89），尤其是在 ERCP 前 30 分钟以上开始输注甲磺酸加贝酯的亚组中（风险比：0.45，95%CI：0.29 至 0.72）。
本研究发现甲磺酸加贝酯可能是 ERCP 患者预防胰腺炎的一种选择，且提示在 ERCP 前 30 分钟开始给药更有利。这一证据可能有助于改善 PEP 的临床预防。
