Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, 95, Yongan Road, Xicheng District, Beijing, 100050, China.
Dig Dis Sci. 2024 Sep;69(9):3134-3146. doi: 10.1007/s10620-024-08565-9. Epub 2024 Aug 5.
Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) remains the most frequent and severe complication following ERCP, elevating both patient suffering and healthcare costs, and posing challenges to the advancement of ERCP techniques. Empirical evidence supports the prophylactic use of nonsteroidal anti-inflammatory drugs (NSAIDs) in the prevention of PEP, especially in high-risk populations, as endorsed by both the American Society for Gastrointestinal Endoscopy (ASGE) and the European Society for Gastrointestinal Endoscopy (ESGE). However, the prophylactic efficacy of NSAIDs in average-risk individuals, alongside the ideal drug selection, dosing, and timing of NSAID administration, remains to be elucidated. Furthermore, the synergistic preventive potential of NSAIDs when integrated with other interventions, such as hydration, pancreatic stenting, somatostatin administration, sublingual nitrate application, and epinephrine, warrants further clarification. In this paper, we conduct an exhaustive review of the prophylactic effect and clinical administration of NSAIDs for PEP. We comprehensively synthesize findings from clinical trials investigating NSAIDs, both in monotherapy and combination regimens, for PEP prevention. Additionally, we scrutinize the current landscape of NSAID usage in clinical practice and evaluate their cost-effectiveness. Future research should concentrate on refining NSAID prophylaxis strategies for PEP in patients at different risk levels, while also enhancing adherence to clinical guidelines and alleviating the issue of NSAID cost inflation.
经内镜逆行胰胆管造影（ERCP）术后胰腺炎（PEP）仍然是 ERCP 后最常见和最严重的并发症，不仅增加了患者的痛苦和医疗保健成本，也对 ERCP 技术的发展提出了挑战。经验证据支持预防性使用非甾体抗炎药（NSAIDs）预防 PEP，尤其是在高危人群中，这得到了美国胃肠内镜学会（ASGE）和欧洲胃肠内镜学会（ESGE）的认可。然而，NSAIDs 在一般风险人群中的预防效果，以及理想的药物选择、剂量和 NSAID 给药时间，仍有待阐明。此外，NSAIDs 与其他干预措施（如补液、胰管支架置入、生长抑素给药、舌下硝酸盐应用和肾上腺素）联合应用的协同预防潜力也需要进一步澄清。在本文中，我们对 NSAIDs 预防 PEP 的预防效果和临床应用进行了全面的回顾。我们综合了 NSAIDs 单药治疗和联合治疗预防 PEP 的临床试验结果。此外，我们还仔细研究了 NSAID 在临床实践中的使用现状，并评估了其成本效益。未来的研究应集中于完善不同风险水平患者的 PEP NSAID 预防策略，同时提高对临床指南的依从性，并缓解 NSAID 成本膨胀问题。
