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首页> 外文期刊>Endoscopy International Open >Post-endoscopic retrograde cholangiopancreatography pancreatitis prevention using topical epinephrine: systematic review and meta-analysis
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Post-endoscopic retrograde cholangiopancreatography pancreatitis prevention using topical epinephrine: systematic review and meta-analysis

机译：后内窥镜逆行胆管胆癌胰腺炎使用局部肾上腺素预防：系统评价和荟萃分析

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Background and study aims Post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) is a common complication of endoscopic retrograde cholangiopancreatography (ERCP). Multiple drugs and techniques have been studied for the prevention of PEP. Topical epinephrine has shown mixed results and is still not widely accepted as an alternative for prevention of PEP. We performed a systematic review and meta-analysis to evaluate the efficacy of topical epinephrine in preventing PEP. Methods A comprehensive literature review was conducted by searching Cochrane library database, Embase and PubMed up to August 2019, to identify all studies that evaluated use of topical epinephrine alone or in conjunction with other agents for prevention of PEP. Outcomes included prevention of PEP with use of topical epinephrine and evaluation of whether addiing epinephrine provides any additional benefit in preventing PEP. All analysis was conducted using Revman 5.3. Results Eight studies, including six randomized controlled trials and two observational studies with 4123 patients, were included in the meta-analysis. Overall, there was no difference in incidence of PEP in patients who underwent ERCP and were treated with epinephrine spray versus those who were not, RR?=?0.63 (CI 0.32–1.24) with heterogeneity (I2?=?72?%). However, on a subgroup analysis, topical epinephrine significantly decreases the risk of PEP when compared to placebo alone (means no intervention was done including no rectal indomethacin)., RR?=?0.32 (0.18–0.57). In another subgroup analysis, there was no statistically significant difference in using topical epinephrine along with rectal indomethacin in preventing PEP compared to rectal indomethacin alone RR?=?0.87 (0.46–1.64). Conclusion Topical epinephrine does not provide any additional benefit in preventing PEP when used in conjunction with rectal indomethacin. In subgroup analysis, topical epinephrine appeared to decrease risk of PEP in the absence of rectal indomethacin, and could be considered when rectal indomethacin is unavailable or if there is a contraindication to its use.
机译：背景和研究旨在后内窥镜逆行胆管胰岛素胰腺炎（PEP）是内窥镜逆行胆管癌（ERCP）的常见并发症。已经研究了多种药物和技术用于预防PEP。局部肾上腺素显示了混合结果，仍然没有被广泛接受作为预防PEP的替代方案。我们进行了系统审查和荟萃分析，以评估局部肾上腺素预防PEP的疗效。方法通过在2019年8月进行Cochrane Library数据库，努力和Pubmed来进行全面的文献综述，识别所有评估使用局部肾上腺素的所有研究，也可以与其他代理商一起预防PEP。结果包括预防PEP与局部肾上腺素的使用和评价Addiing Epinephrine在预防PEP中提供任何额外的益处。所有分析都使用Revman 5.3进行。结果八项研究，包括六项随机对照试验和具有4123名患者的两个观察性研究，包括在荟萃分析中。总体而言，接受ERCP的患者的PEP发病率没有差异，并用肾上腺喷雾与那些的肾上腺素喷雾，RR？=Δ= 0.63（CI 0.32-1.24），具有异质性（I2？=Δ72？％）。然而，在亚组分析中，与单独的安慰剂相比，局部肾上腺素显着降低PEP的风险（意味着没有干预，包括没有直肠吲哚美辛）。，RR？= 0.32（0.18-0.57）。在另一个亚组分析中，使用局部肾上腺素与直肠吲哚美辛相比，与直肠吲哚美辛相比，使用局部肾上腺素与直肠吲哚美辛相比，没有统计学上显着差异。结论局部肾上腺素在与直肠吲哚美辛结合使用时不能提供任何额外的益处。在亚组分析中，局部肾上腺素似乎在没有直肠吲哚美辛的情况下降低PEP的风险，并且当直肠吲哚美辛不可用或者如果使用禁忌症时可以考虑。

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