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首页> 外文期刊>Endoscopy International Open >Nonsteroidal anti-inflammatory drugs versus placebo for post-endoscopic retrograde cholangiopancreatography pancreatitis: a systematic review and meta-analysis
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Nonsteroidal anti-inflammatory drugs versus placebo for post-endoscopic retrograde cholangiopancreatography pancreatitis: a systematic review and meta-analysis

机译：非甾体抗炎药与安慰剂治疗内镜逆行胰胆管造影胰腺炎的系统评价和荟萃分析

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Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) is the primary therapeutic procedure for treatment of diseases that affect the biliary tree and pancreatic duct. While the therapeutic success rate of ERCP is high, the procedure can cause complications, such as acute pancreatitis (PEP), bleeding, and perforation. This meta-analysis aimed to assess the efficacy of nonsteroidal anti-inflammatory drugs (NSAIDs) in preventing PEP following (ERCP). Materials and methods We searched databases, such as MEDLINE, Embase, and Cochrane Central Library. Only randomized controlled trials (RCTs) that compared the efficacy of NSAIDs and placebo for the prevention of PEP were included. Outcomes assessed included incidence of PEP, severity of pancreatitis, route of administration, and type of NSAIDs. Results Twenty-one RCTs were considered eligible with a total of 6854 patients analyzed. Overall, 3427 patients used NSAIDs before ERCP and 3427 did not use the drugs (control group). In the end, 250 cases of acute pancreatitis post-ERCP were diagnosed in the NSAIDs group and 407 cases in the placebo group.?Risk for PEP was lower in the NSAID group (risk difference (RD): ?0.05; 95?% confidence interval (CI): ?0.07 to?–?0.03; number need to treat (NNT), 20; P ?0.05). Use of NSAIDs effectively prevented mild pancreatitis compared with use of placebo (2.5?% vs. 4.1?%; 95?% CI, ?0.05 to?–?0.01; NNT, 33; P ?0.05), but the information on moderate and severe PEP could not be completely elucidated. Only rectal administration reduced incidence of PEP (6.8?% vs. 13?%; 95?% CI, ?0.10 to?–?0.04; NNT, 20; P ?0.05). Furthermore, only diclofenac or indomethacin use was effective in preventing PEP. Conclusions Rectal administration of diclofenac and indomethacin significantly reduced risk of developing mild PEP. Further RCTs are needed to compare efficacy between NSAID administration pathways in prevention of PEP after ERCP.
机译：背景和研究目的内镜逆行胰胆管造影术（ERCP）是治疗影响胆管树和胰管的疾病的主要治疗方法。尽管ERCP的治疗成功率很高，但该过程可能会引起并发症，例如急性胰腺炎（PEP），出血和穿孔。这项荟萃分析旨在评估非甾体抗炎药（NSAID）在预防PEP继发（ERCP）方面的功效。材料和方法我们搜索了MEDLINE，Embase和Cochrane中央图书馆等数据库。仅包括比较NSAID和安慰剂预防PEP疗效的随机对照试验（RCT）。评估的结果包括PEP的发生率，胰腺炎的严重程度，给药途径和非甾体抗炎药的类型。结果21例RCT被视为符合条件，共分析了6854例患者。总体上，有3427例患者在ERCP之前使用了NSAID，而3427例患者未使用药物（对照组）。最终，NSAIDs组被诊断为250例ERCP后急性胰腺炎，安慰剂组被诊断为407例.NSAID组的PEP风险较低（风险差异（RD）：0.05,95％置信度）区间（CI）：? 0.07至？-？0.03;需要治疗的人数（NNT），20; P <？0.05）。与使用安慰剂相比，使用NSAID可以有效预防轻度胰腺炎（2.5 %% vs.4.1 %%; 95 %% CI，？0.05至？-？0.01; NNT，33; P <？0.05），但有关中度的信息并不能完全阐明严重的PEP。仅直肠给药降低了PEP的发生率（6.8％vs. 13％; 95％CI，从0.10至0.04; NNT，20; P <0.05）。此外，仅使用双氯芬酸或消炎痛可有效预防PEP。结论直肠给药双氯芬酸和消炎痛可显着降低发生轻度PEP的风险。还需要进一步的RCT，以比较NSAID给药途径在ERCP后预防PEP方面的功效。

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