Comparison of therapeutic methods (pharmacologic and nonpharmacologic) on prevention of post ERCP pancreatitis: A systematic review and meta-analysis

Abstract

PEP is by far, one of the most common complications of ERCP. In this regard different approaches have been suggested to prevent or reduce this complications but there are no universally accepted method. Administration of NSAIDs like indomethacin and diclofenac or hydration with normal saline or lactated ringer's solution are recommended for prevention of PEP. Additionally, pancreatic stent placement (PSP), introduced in the late 1990s, has become common clinical practice in the United States and is widely regarded as an effective means of preventing PEP in high-risk cases. However, to the best of our knowledge, there is no systematic review and meta-analysis to summarize the results of studies comparing therapeutic methods (pharmacologic and nonpharmacologic) on prevention of post ERCP pancreatitis. So, in this systematic review and meta-analysis, we tend to investigate the relevant literature to compare the effectiveness of NSAID, hydration and pancreatic stent placement or the combination of these methods in prevention of PEP. Material and Methods: This study was performed in 2019 using Pubmed, Embase and Cochrane library. Two reviewers selected eligible studies and outcomes of interest were extracted. Meta-analysis was done by using the random and fixed effect models. I-square statistic test was used for heterogeneity analysis. Presence of publication bias was also checked. Results: 2758 articles were found by our systematic search. After excluding of duplicated and irrelevant articles, finally six articles were entered our study. Six RCTs were considered eligible with a total participants of 1685. According to the results, the relative risk of PEP was not significantly different in NSAID and hydration groups (Pooled RR=1.19, 95%CI: 0.40 to 3.50, P-value=0.74). The random effect model indicated no significant differences between NSAID and NSAID+hydration groups regarding the incidence of PEP (Pooled RR=2.19, 95%CI: 0.70 to 6.88, P-value=0.17). Also, the relative risk of PEP was 2.65 times higher in hydration group compared with NSAID+hydration group (Pooled RR=2.65, 95%CI: 1.08 to 4.47, P-value=0.03). In addition, he results of one study showed that rectal indomethacin alone appeared to be more effective for preventing PEP than no prophylaxis, PSP alone, and the combination of indomethacin and PSP.