Rectal nonsteroidal anti-inflammatory drugs administration is effective for the prevention of post-ERCP pancreatitis: An updated meta-analysis of randomized controlled trials

Yang, Chong; Zhao, Yang; Li, Wentao; Zhu, Shaihong; Yang, Hongji; Zhang, Yu; Liu, Xi; Peng, Nan; Fan, Ping; Jin, Xin

doi:10.1016/j.pan.2017.07.008

Cited by 42 publications

(33 citation statements)

References 34 publications

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“…Recent RCTs and meta‐analyses have shown that NSAIDs can significantly reduce the incidence of PEP in high‐risk patients. The route of administration and dosage have also been evaluated, showing that rectal administration of NSAIDs within 30 minutes before or after ERCP is effective in preventing PEP, while its oral or intramuscular administration is not . A meta‐analysis of 24 clinical studies concluded that indomethacin and diclofenac could significantly reduce the incidence of mild PEP, although there was no significant reduction in moderate‐to‐severe PEP.…”

Section: Medical Prevention Of Post‐ercp Complicationsmentioning

confidence: 84%

“…The subgroup analysis also revealed rectal administration to be superior than other routes . On the contrary, two other meta‐analyses that included 9 and 12 RCTs, respectively, suggested that NSAIDs significantly reduced the risk of moderate and severe PEP in both high‐ and low‐risk patients . Further, a recent RCT with 70% of the patients at an average risk for PEP reported no statistically significant difference in PEP when treated with rectally administered 100 mg indomethacin compared with placebo in patients who underwent non‐selective ERCP .…”

Section: Medical Prevention Of Post‐ercp Complicationsmentioning

confidence: 88%

“…The route of administration and dosage have also been evaluated, showing that rectal administration of NSAIDs within 30 minutes before or after ERCP is effective in preventing PEP, while its oral or intramuscular administration is not. [49][50][51][52] A meta-analysis of 24 clinical studies concluded that indomethacin and diclofenac could significantly reduce the incidence of mild PEP, although there was no significant reduction in moderate-to-severe PEP. The subgroup analysis also revealed rectal administration to be superior than other routes.…”

Section: Medications With Established Efficacymentioning

confidence: 99%

See 2 more Smart Citations

Chinese expert consensus on perioperative medications for endoscopic retrograde cholangiopancreatography (ERCP)

Bai

Wang

et al. 2019

J of Digest Diseases

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Section: Medical Prevention Of Post‐ercp Complicationsmentioning

confidence: 84%

Section: Medical Prevention Of Post‐ercp Complicationsmentioning

confidence: 88%

Section: Medications With Established Efficacymentioning

confidence: 99%

See 1 more Smart Citation

Chinese expert consensus on perioperative medications for endoscopic retrograde cholangiopancreatography (ERCP)

Bai

Wang

et al. 2019

J of Digest Diseases

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“…Multiple RCTs, meta-analyses, and systematic reviews indicate that rectal non-steroidal anti-inflammatory drugs (NSAIDs) (diclofenac or indomethacin) reduce PEP onset 85– 88 and moderate to severe PEP. The literature is inconclusive regarding whether rectal NSAIDs should be administered prior to or immediately after ERCP 89, 90 .…”

Section: Recent Advances In Early Treatment Of Acute Pancreatitismentioning

confidence: 99%

Recent advances in understanding and managing acute pancreatitis

Mandalia¹,

Wamsteker²,

DiMagno³

2018

F1000Res

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This review highlights advances made in recent years in the diagnosis and management of acute pancreatitis (AP). We focus on epidemiological, clinical, and management aspects of AP. Additionally, we discuss the role of using risk stratification tools to guide clinical decision making. The majority of patients suffer from mild AP, and only a subset develop moderately severe AP, defined as a pancreatic local complication, or severe AP, defined as persistent organ failure. In mild AP, management typically involves diagnostic evaluation and supportive care resulting usually in a short hospital length of stay (LOS). In severe AP, a multidisciplinary approach is warranted to minimize morbidity and mortality over the course of a protracted hospital LOS. Based on evidence from guideline recommendations, we discuss five treatment interventions, including intravenous fluid resuscitation, feeding, prophylactic antibiotics, probiotics, and timing of endoscopic retrograde cholangiopancreatography (ERCP) in acute biliary pancreatitis. This review also highlights the importance of preventive interventions to reduce hospital readmission or prevent pancreatitis, including alcohol and smoking cessation, same-admission cholecystectomy for acute biliary pancreatitis, and chemoprevention and fluid administration for post-ERCP pancreatitis. Our review aims to consolidate guideline recommendations and high-quality studies published in recent years to guide the management of AP and highlight areas in need of research.

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“…In previous studies, suppository Voltaren was shown to have a role in reducing the incidence of post-ERCP PEP, although mostly not statistically significant. In two meta-analysis, overall benefit is seen in its forest plot, favoring rectal NSAIDs in the reduction of PEP [8,9,19,20].…”

Section: Previous Post-ercp Pepmentioning

confidence: 99%

A Less Invasive Method of Reducing the Incidence of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis: Intravenous Diclofenac Sodium Versus Placebo

Chik

Jarmin

Ariffin

et al. 2018

Asian J Pharm Clin Res

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Objective: The purpose of this study is to reduce the incidence of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) by the administration of intravenous (IV) diclofenac sodium.Methods: This is a prospective, randomized, double-blinded control study. This study was performed in the hepatobiliary unit of general surgery department in University Kebangsaan Malaysia Medical Centre (UKMMC) from May 2015 to May 2016. A total of 128 patients were enrolled in this study. 59 patients were randomized into the treatment arm, while 63 were randomized into the control group. Patients were randomized by envelope system, and patients in the treatment arm received 75 mg of diclofenac sodium intravenously, within 30 min of ERCP commencement. Both groups were observed for PEP post-ERCP and their pain score recorded. Patients’ demographic data were also observed.Results: A total of 122 patients were included in the study, with 59 patients randomized into the treatment arm and 63 into the placebo arm. There was an increase of 7.6% PEP rates in the placebo group (12.7% vs. 5.1% in the treatment arm). However, this was not statistically significant (p=0.142)Conclusion: This study shows that IV diclofenac sodium can decrease PEP but is not statistically significant.

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Rectal nonsteroidal anti-inflammatory drugs administration is effective for the prevention of post-ERCP pancreatitis: An updated meta-analysis of randomized controlled trials

Cited by 42 publications

References 34 publications

Chinese expert consensus on perioperative medications for endoscopic retrograde cholangiopancreatography (ERCP)

Chinese expert consensus on perioperative medications for endoscopic retrograde cholangiopancreatography (ERCP)

Recent advances in understanding and managing acute pancreatitis

A Less Invasive Method of Reducing the Incidence of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis: Intravenous Diclofenac Sodium Versus Placebo

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