Pharmacological Prevention For Post-ERCP Pancreatitis: A Systematic Review Of Randomized Controlled Trials

Objective: The aim of the systematic review is to assess the effectiveness and safety of pharmacological prevention for post-ERCP pancreatitis (PEP). Methods: Trials were identified by searching Cochrane Controlled Trials Register, Medline, Embase, China Biological Medicine Database (CBM-disc). We handsearched the data from the proceedings of correlated conferences, ten kinds of important Chinese journals and references of all included trials. Two reviewers assessed the quality of studies, extracted data independently. Disagreements were resolved by discussion or the third party when needed. The following primary outcomes were assessed: 1) Incidence of PEP. 2) Incidence of severe PEP. 3)Mortality of PEP. 4)Adverse events. Secondary outcomes were: 1) Incidence of post-ERCP hyperamylasemia. 2) Incidence of post-ERCP abdominal pain.Results: Fifty-one trials involving 10331 patients were included. Of which 21 trials had adequate concealment of randomization, 26 trials implementdouble-blind, 2 trials implement single-blind, 11 trials reported dropouts and missing data, 3 trials used intention to treatment analysis. Meta-analysis showed that somatostatin(p=0.00001,OR 0.33 (95% CI 0.20 to 0.54), ), glyceryl trmitrate(p=0.004,OR 0.33 ( 95% CI 0.16 to 0.71 ) ), antibiotics(p=0.02,OR 0.36 ( 95% CI 0.15 to 0.87 ) ), non-steroid anti-inflammatory drugs(p=0.04,OR 0.37 (95% CI 0.15 to 0.94) ) can reduce the incidence of PEP. There is no significance between pharmacological prevention group and control group in the incidence of severe PEP. Only 2 cases dead of PEP in two trials, both occurred in control group. 13 trials reported adverse events, of which 8 trials reported no evident adverse events were seen. Only 5 trials reported the details of adverse events, but none of them needed special treatment. We can't evaluate the safety of pharmacological prevention using the limited data.Conclusion: Somatostatin, glyceryl trinitrate, antibiotics, non-steroid anti-inflammatory drugs can reduce the incidence of PEP. The evidence at present do not support that octreotide, antiproteasic agents, corticosteroids, interleukinlO( IL-10), calcium channel blockers can reduce the incidence of PEP. The evidence about antiproteasic agents, glyceryl trinitrate, IL-10, calcium channel blockers and non-steroid anti-inflammatory drugs were limited, the results should be looked with cautious, and further high-quality randomized controlled trials should be performed. Enough evidence proved that octreotide and corticosteroids can not prevent for PEP, there is no need toperform further clinical trials. Somatostatin can be used to prevent for PEP clinically; antibiotics can be used to prevent for complication of ERCP in clinical because of the effect of prophylaxis for cholangitis and septicemia in the same time although the effect of preventing PEP should be looked with cautious.