The Effectiveness And Safety Of Non-Steroidal Anti-Inflammatory Drugs In Prevention Of Post-ERCP Pancreatitis:a Systematic Review

Objective To evaluate the effectiveness and safety of non-steroidal anti-inflammatory drugs (NSAIDs) in the preventing and treating PEP by performing a meta-analysis of randomized controlled trials(RCTs).Methods PubMed?Embase?Web of Science?Cochrane Library?Ovid were searched by two independent reviewers for relevant randomized controlled trials (RCTs),The search terms were NSAID?Diclofenac\ Indomethacin?post-ERCP pancreatitis?PEP, The searching date was from the found of each database to March20,2015. Two reviewers extracted data and assessed quality independently, All data were analyzed with Revman 5.0 software.Results A total of 9 trials involving 2648 patients that underwent ERCP were included, with 1318 patients in the NSAID group and 1330 patients in the control group. The Meta-analysis showed that NSAIDs can reduce the incidence of PEP (RR=0.54,95%CI=0.42 to 0.69,P<0.00001). The 2-hour serum amylase level after ERCP can also be reduced (WMD=-89.5,95%CI=-147.51 to -31.49,P=0.002). There was no significant difference between NSAID group and control group in the aspects of 24-hour serum amylase level after ERCP (WMD=-24l.62,95%CI=-494.51 to 11.27, P=0.06). Moreover, The subgroup analysis revealed that the administration of NSAIDs as a rectal suppository (RR= 0.49,95%CI:0.37 to 0.65; P<0.00001) was more effective than oral administration (RR= 0.97,95%CI:0.53 to 1.80; P=0.93) or through infusion (RR= 0.43,95%CI: 0.12 to 1.54;P=0.19).Conclusions Prophylactic use of NSAIDs can significantly reduce the incidence of PEP.