Meta-analysis: rectal indomethacin for the prevention of post-ERCP pancreatitis

Yaghoobi, Mohammad; Rolland, Sébastien; Waschke, Kevin; McNabb‐Baltar, Julia; Martel, Myriam; Bijarchi, Raheleh; Szego, Peter; Barkun, Alan N.

doi:10.1111/apt.12488

Cited by 70 publications

(53 citation statements)

References 25 publications

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“…Number needed to treat was 20. Moreover they found that in subgroup analysis, the difference remained unchanged for average-risk population [OR = 0.49 (0.28-0.85); P = 0.01] or in preventing severe PEP [OR = 0.41 (0.21-0.78); P = 0.007] [50] . The European Society of Gastrointestinal Endoscopy published guidelines in 2010 with grade A recommendation for the administration of rectal diclofenac 100 mg or indomethacin immediately before or after ERCP as post-ERCP prophylaxis [51] .…”

Section: Interruption Of Inflammatory Cascade (Anti-inflammatory): Nomentioning

confidence: 99%

Prevention of post-ERCP pancreatitis

Wong

Tsai

2014

WJGP

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Post-procedure pancreatitis is the most common complication of endoscopic retrograde cholangio pancreatography (ERCP) and carries a high morbidity and mortality occurring in at least 3%-5% of all procedures. We reviewed the available literature searching for "ERCP" and "pancreatitis" and "post-ERCP pancreatitis". in PubMed and Medline. This review looks at the diagnosis, risk factors, causes and methods of preventing post-procedure pancreatitis. These include the evidence for patient selection, endoscopic techniques and pharmacological prophylaxis of ERCP induced pancreatitis. Selecting the right patient for the procedure by a risk benefits assessment is the best way of avoiding unnecessary ERCPs. Risk is particularly high in young women with sphincter of Oddi dysfunction (SOD). Many of the trials reviewed have rather few numbers of subjects and hence difficult to appraise. Meta-analyses have helped screen for promising modalities of prophylaxis. At present, evidence is emerging that pancreatic stenting of patients with SOD and rectally administered nonsteroidal anti-inflammatory drugs in a large unselected trial reduce the risk of post-procedure pancreatitis. A recent meta-analysis have demonstrated that rectally administered indomethecin, just before or after ERCP is associated with significantly lower rate of pancreatitis compared with placebo [OR = 0.49 (0.34-0.71); P = 0.0002]. Number needed to treat was 20. It is likely that one of these prophylactic measures will begin to be increasingly practised in high risk groups.© 2014 Baishideng Publishing Group Co., Limited. All rights reserved. Key words: Acute pancreatitis; Endoscopic retrograde cholangio pancreatographyCore tip: Select patients carefully, and give high risk patients rectal indomethacin.Wong LL, Tsai HH. Prevention of post-ERCP pancreatitis.

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Section: Interruption Of Inflammatory Cascade (Anti-inflammatory): Nomentioning

confidence: 99%

Prevention of post-ERCP pancreatitis

Wong

Tsai

2014

WJGP

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“…[120][121][122][123][124][125][126][127] Validity of these conclusions could be questioned however, due to some findings which was difficult to explain or discordant to each other. 128 Several of the early PRCT reported that RNSAID (diclofenac) significantly reduced PEP in average-risk patients.…”

Section: Post-ercp Prophylaxismentioning

confidence: 99%

Endoscopic retrograde cholangiopancreatography complications: Techniques to reduce risk and management strategies

Tarnasky

Kedia

2017

Int J Gastrointest Interv

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Adverse events after endoscopic retrograde cholangiopancreatography (ERCP) are not uncommon and can be associated with tragic outcomes. Bleeding, perforation, and post-ERCP pancreatitis are the most common complications. Some events are unavoidable; others are associated with well described risk factors so that they can be either anticipated and/or measures can be taken for prevention or at least risk reduction. This review will focus on the more common complications after ERCP, their risk factors, and potential strategies for risk reduction. Additionally, recommendations for management of ERCP complications will be presented.

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“…In the past decade, there have been at least six RCTs showing that NSAIDs reduce risk of PEP by 50-60 % [26][27][28][29][30][31]. In addition, there have been five meta-analyses in the past 4 years demonstrating a reduction in PEP with a number needed to treat ranging from 11 for the prevention of mild up to 34 to prevent moderate-to-severe pancreatitis [32][33][34][35][36].…”

Section: Pharmacoprophylaxismentioning

confidence: 99%

Preventing Post-ERCP Pancreatitis: Update 2016

Freeman

2016

Curr Treat Options Gastro

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Post-ERCP remains a major challenge, although significant progress has been made in predicting risk and methods of prevention. Facets of post-ERCP pancreatitis can be divided into the four "P's": they are patient-related factors, procedure-related factors, pancreatic stents, and pharmacoprophylaxis. New information about risk factors includes a description of IPMN as a patient-related risk, with smoking and chronic liver disease as protective factors. Procedure-related factors include one or more deep passages of a guidewire into the pancreatic duct as a salient risk, perhaps outweighing difficult cannulation or contrast injection, but one that can be mitigated by placement of a pancreatic stent. In addition, placement of transpapillary metallic stents has emerged as an independent risk for post-ERCP pancreatitis (PEP). Although there has been a rising wave of enthusiasm for rectal NSAIDs as a kind of panacea for prevention of post-ERCP pancreatitis, the newest data question their efficacy in unselected cohorts. Pancreatic stent placement remains the most proven and reliable method of preventing post-ERCP pancreatitis in both mixed- and high-risk ERCP. Success at placement of protective pancreatic stents is a paramount for safety and efficacy, and technical expertise at placing pancreatic stents widely among centers. The use of specialized techniques including very small caliber guidewires and stents is necessary to approach 100 % success.

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Meta-analysis: rectal indomethacin for the prevention of post-ERCP pancreatitis

Abstract: SUMMARY BackgroundDespite initial evidence in the literature, nonsteroidal anti-inflammatory drugs (NSAIDs) have not been widely used to prevent post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP).

Cited by 70 publications

References 25 publications

Prevention of post-ERCP pancreatitis

Prevention of post-ERCP pancreatitis

Endoscopic retrograde cholangiopancreatography complications: Techniques to reduce risk and management strategies

Preventing Post-ERCP Pancreatitis: Update 2016

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