Department of Hepatobiliary-Pancreatic Surgery, Affiliated Hospital of Qinghai University, Xining, 810000, China.
Graduate School of Qinghai University, Xining, 810000, China.
J Gastrointest Surg. 2022 Sep;26(9):1982-1997. doi: 10.1007/s11605-022-05352-7. Epub 2022 Jun 9.
To systematically evaluate the clinical efficacy of rectal nonsteroidal anti-inflammatory drugs (NSAIDs) alone or in combination with other agents for preventing pancreatitis after endoscopic retrograde cholangiopanography.
We carried out a literature search of random controlled trials (RCTs) on preventing post-operative pancreatitis by administration of the anti-inflammatory drugs, indomethacin and diclofenac, following endoscopic retrograde cholangiopancreatography (ERCP). The databases searched for relevant publications up to July 7, 2021, included PubMed, Cochrane Library, and Embase. We screened the literature according to inclusion criteria and analyzed the extracted data. The overall population and high-risk patient groups were analyzed, with the main outcome being the incidence of PEP.
The search identified 32 RCTs that included 15019 patients with post-ERCP pancreatitis and 9 different interventions. The results of the overall population network meta-analysis showed that NSAIDs alone, high-dose NSAIDs, and a combination of NSAIDs significantly reduced the incidence of PEP compared with placebo. However, compared with placebo, there was no statistically significant difference between the two interventions (NSAIDs + standard hydration and high-dose NSAIDs). In addition, NSAIDs + sublingual nitrates were associated with a lower incidence of PEP compared to that observed with NSAIDs alone. Probability ranking results showed that NSAIDs + sublingual nitrate had the best effect, followed by NSAIDs + standard hydration, NSAIDs + melatonin, NSAIDs + aggressive hydration, NSAIDs + somatostatin, NSAIDs alone, NSAIDs + epinephrine, high-dose NSAIDs, and placebo. In the high-risk subgroup, the results of the network meta-analysis showed that NSAIDs alone, high-dose NSAIDs, and a combination of NSAIDs showed no statistically significant difference in their ability to reduce the incidence of PEP compared with placebo. Probability ranking results showed that NSAIDs + hydration had the best effect, followed by NSAIDs + sublingual nitroglycerin and NSAIDs + aggressive hydration.
Of the nine interventions, NSAIDs + sublingual nitrates had considerably better efficacy than the other drugs for reducing the incidence of PEP in the overall population. In high-risk patients, NSAIDs + standard hydration may be the best preventive treatment; however, more randomized, controlled trials are needed to validate our results.
Name of the registry: PROSPERO-International prospective register of systematic reviews. Unique identifying number or registration ID: CRD42021282205.
系统评价直肠应用非甾体抗炎药（NSAIDs）单独或联合其他药物预防内镜逆行胰胆管造影（ERCP）术后胰腺炎的临床疗效。
我们对预防 ERCP 术后胰腺炎的抗炎药物（吲哚美辛和双氯芬酸）的随机对照试验（RCT）进行了文献检索。检索相关文献的数据库截止日期为 2021 年 7 月 7 日，包括 PubMed、Cochrane 图书馆和 Embase。我们根据纳入标准筛选文献并分析提取的数据。对总体人群和高危人群进行分析，主要结局为 PEP 的发生率。
检索出 32 项 RCT，共纳入 15019 例 ERCP 术后胰腺炎患者和 9 种不同干预措施。总体人群网络荟萃分析结果显示，与安慰剂相比，NSAIDs 单独应用、高剂量 NSAIDs 以及 NSAIDs 联合应用均可显著降低 PEP 的发生率。然而，与安慰剂相比，两种干预措施之间无统计学差异（NSAIDs+标准水化和高剂量 NSAIDs）。此外，与 NSAIDs 单独应用相比，NSAIDs+舌下硝酸盐可降低 PEP 的发生率。概率排序结果显示，NSAIDs+舌下硝酸盐效果最佳，其次是 NSAIDs+标准水化、NSAIDs+褪黑素、NSAIDs+积极水化、NSAIDs+生长抑素、NSAIDs 单独应用、NSAIDs+肾上腺素、高剂量 NSAIDs 和安慰剂。在高危亚组中，网络荟萃分析结果显示，与安慰剂相比，NSAIDs 单独应用、高剂量 NSAIDs 以及 NSAIDs 联合应用降低 PEP 发生率的能力无统计学差异。概率排序结果显示，NSAIDs+水化效果最佳，其次是 NSAIDs+舌下硝酸甘油和 NSAIDs+积极水化。
在这 9 种干预措施中，与其他药物相比，NSAIDs+舌下硝酸盐在降低总体人群 PEP 发生率方面具有显著更好的疗效。在高危患者中，NSAIDs+标准水化可能是最佳的预防治疗方法；然而，还需要更多的随机对照试验来验证我们的结果。
注册名称：PROSPERO-国际系统评价前瞻性登记册。独特识别号码或注册 ID：CRD42021282205。
