Systematic Review And Meta-analysis Of Using Indomethacin To Prevent Of Post-ERCP Pancreatitis

Background and Objective: With the extensive application of Endoscopic Retrograde Cholangiopancreatography,the syndrome along with it becomes more and more,expecially Post-Endoscopic Retrogrede Cholangiopancreatography Pancreatitis.How to effectively prevent PEP has become important subject of clinical study.Some studies have shown that indomethacin can prevent the occurrence of PEP,but the conclusions are inconsistent.Therefore,this study is to evaluate the preventative effect of indomethacin against PEP and to provid new evidence of evidence-based medicine for clinic.Method: Pubmed,EMBASE and Cochrane Library database were searched from January 1968 to March 2017.All randomized controlled trials on indomethacin preventing PEP were checked.Study subjects were patients who received ERCP examination and treatment.Study indicator was the incidence rate of PEP.Two researchers independently screened all literatures,extracted the data and evaluated quality according to inclusion and exclusion criteria.Meta-analysis was performed using RevMan version 5.3 software.Result: A total of 8 studies involving 3241 participants were identified.In the trial group,1643 patients were treated with indomethacin.In the control group,1598 patients were treated with placebo.The results of meta-analysis show that rectal application of indomethacin can effectively reduce the incidence of PEP(RR = 0.60,95% CI 0.43-0.83,P <0.05),the difference was statistically significant compared with the control group.Subgroup analysis further show :1.Rectal application of indomethacin can effectively reduce the incidence of moderate and severe PEP(RR=0.54,95%CI 0.33-0.89,P<0.05),the difference was statistically significant compared with the control group.2.Indomethacin can reduce the incidence of PEP in high-risk groups(RR=0.43,95%CI 0.28-0.65,P<0.05),the difference was statistically significant compared with the control group.Indomethacin can not effectively reduce the incidence of PEP in average-risk groups(RR=0.74,95%CI 0.52-1.07,P=0.11),the difference was statistically significant compared with the control group.3.Indomethacin can significantly reduce the incidence of PEP in Oddi sphincterotomy(RR=0.56,95%CI 0.42-0.73,P<0.05),the difference was statistically significant compared with the control group.4.Indomethacin can significantly reduce the incidence of moderate and severe PEP in Oddi sphincterotomy(RR=0.44,95%CI 0.26-0.76,P<0.05),the difference was statistically significant compared with the control group.5.The incidence of PEP was reduced in patients treated with indomethacin preoperatively(RR=0.59,95%CI 0.43-0.80,P<0.05),the difference was statistically significant compared with the control group.The incidence of PEP was reduced in patients treated with indomethacin postoperatively(RR=0.42,95%CI 0.20-0.88,P<0.05),the difference was statistically significant compared with the control group.Conclusion:The incidence of PEP in patients with rectal administration of indomethacin can be reduced significantly.The incidence of PEP in high-risk population with rectal administration of indomethacin can be reduced significantly compared with average-risk population.It also can be reduced significantly in Oddi sphincterotomy.The results were not related to the application time of indomethacin.