| Background:Endoscopic retrograde cholangiopancreatography has become an important method for the diagnosis and treatment of diseases of the pancreatic system.It has the advantages of less trauma and good diagnosis and treatment,but there are also many complications,such as intestinal perforation,cholangitis,Gastrointestinal bleeding,etc.The higher incidence of complications is post-ERCP(post-ERCP pancreatitis,PEP),there are many clinical methods to prevent PEP,the most commonly used is somatostatin and somatostatin derivative octreotide.However,recent studies have shown that somatostatin does not reduce the incidence of PEP,and its effectiveness in preventing PEP has yet to be evaluated,and there is controversy regarding its dosage and method of use.Aim:To systematically evaluate the effectiveness of soma-tostatin for preventing post endoscopic retrograde cholangiopancreatog-raphy pancreatitis and hyperamylasemia and provide guidance for clinical medication.Methods:We searched the Cochrane Library、Pub Med、EMBASE、Wanfang、CNKI、CBM;Literature from the inception date to August 2019 and randomized controlled trials(RCT)about so-matostatin for preventing post-ERCP pancreatitis(PEP)were collected in the study.We use the Rev Man 5.3 software to analyze data.Results:After strict screening,a total of 11 RCTs were included,1622 cases in the somatostatin group,and 1677 cases in the control group.Through analysis,the incidence of PEP in the observation group after applying somatostatin was significantly lower than that in the control group(OR = 0.60,95% CI: 0.44 ～ 0.81,P = 0.0008),and somatostatin also reduced high amylase after ERCP The incidence of anemia(OR = 0.58,95% CI: 0.47 ～ 0.71,P <0.00001).Subgroup analysis results show that the high-dose somatostatin group(≥3mg / 12h)can significantly reduce the incidence of PEP(OR = 0.36,95% CI: 0.23 ～ 0.55,P <0.00001)compared with the control group,which can reduce ERCP The incidence of post-hyperamylemia(OR =0.49,95% CI: 0.37 ～ 0.67,P <0.00001),compared with the control group,it cannot be explained that low dose somatostatin(<3mg / 12h)can reduce the occurrence of PEP Rate(OR = 1.08,95% CI: 0.70 ～ 1.68,P = 0.72),but low-dose somatostatin can reduce the incidence of hyperamylase after ERCP(OR = 0.66,95% CI: 0.50 ～ 0.87,P = 0.004).According to the total time of somatostatin use,it was divided into long-term group(≥12h)and short-term group(<12h).Compared with the control group,prolonged(≥12h)somatostatin can reduce the incidence of PEP(OR = 0.24,95% CI: 0.13 ～ 0.46,P <0.0001),and can also reduce hyperamylaseemia after ERCP Incidence rate(OR = 0.43,95% CI: 0.31 ～ 0.60,P <0.00001).However,the short-term group(<12h)had no preventive effect on PEP(OR = 0.86,95% CI: 0.48～ 1.53,P = 0.6),and could only reduce the incidence of hyperamylaseemia after ERCP(OR = 0.68,95 % CI: 0.53 ～ 0.88,P = 0.0.004).Conclusions:In general,somatostatin has a preventive effect on hyperamylaseemia after PEP and ERCP.Further subgroup analysis shows that high-dose somatostatin can effectively reduce the incidence of hyperamylaseemia after PEP and ERCP.Although somatostatin(<3mg / 12h)can reduce the incidence of hyperamylase after ERCP,it cannot be explained that low-dose somatostatin can reduce the incidence of PEP.The subgroup analysis of the duration of somatostatin treatment also yielded similar results,which cannot explain the short-term application of somatostatin(<12h)has a preventive effect on PEP.Therefore,in general,it is recommended to start applying somatostatin before surgery,and use large doses(≥3mg / 12h)and long-term(≥12h)intravenous drip to reduce the incidence of hyperamylase after PEP and ERCP rate. |
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