Rectal NSAIDs for the prevention of post-ERCP pancreatitis: A meta-analysis of randomized controlled trials

Background and purposeAcute pancreatitis is the most frequent complication of endoscopic retrograde cholangiopancreatography (ERCP). We conducted a meta-analysis to evaluate the efficacy and safety of rectal nonsteroidal anti-inflammatory drugs (NSAIDs) for the prevention of post-ERCP pancreatitis (PEP).MethodsPubMed and Embase databases were searched through April 2013. Results are reported as relative risk (RR) or weighted mean difference (WMD) with 95% confidence interval (95% CI). The primary outcome measure was the incidence of PEP. Secondary outcome measures included the severity of PEP and serum amylase level 2 h, 24 h after ERCP.ResultsSeven trials containing 1846 patients were eligible. Rectal NSAIDs significantly reduced the incidence of PEP (RR 0.45, 95% CI 0.34–0.61, P < 0.001). The results were maintained in subsequent subgroup analysis. Rectal NSAIDs also was associated with a reduction in the incidence of mild PEP (RR 0.54, 95% CI 0.35–0.83, P = 0.005), moderate to severe PEP (RR 0.39, 95% CI 0.22–0.70, P = 0.002), or serum amylase level 2 h after ERCP (WMD −91.09 IU/L, 95% CI −149.78 to −32.40, P = 0.002).ConclusionsRectal NSAIDs reduced the incidence and severity of PEP, as well as serum amylase level 2 h after ERCP.