生长抑素预防ERCP术后胰腺炎及高淀粉酶血症有效性的Meta分析

目的 对应用生长抑素预防内镜逆行胰胆管造影(ERCP)术后胰腺炎(PEP)和ERCP术后高淀粉酶血症(PEHA)的研究进行Meta分析.方法 搜索电子数据库,包括PubMed、EMBASE、Cochrane图书馆和科学引文索引以检索相关试验.纳入比较生长抑素和空白对照预防PEP的对照试验.使用随机效应模型和固定效应模型...

Meta analysis of the effectiveness of somatostatin in preventing pancreatitis and hyperamylasemia after ERCP

Objective To conduct a meta-analysis of somatostatin in preventing post-endoscopic retrograde cholangiopancreatography pancreatitis(PEP)and post-endoscopic retrograde cholangiopancreatography hyperamylasemia(PEHA).Methods The electronic databases,including PubMed,EMBASE,Cochrane Library,and Science Citation Index,were searched to retrieve relevant experiments.A controlled trial comparing somatostatin and blank control to prevent PEP was included.Random effects model and fixed effects model were used for meta-analysis to evaluate the rate of abdominal pain after PEP,PEHA,and ERCP.Results The ratios of PEP and PEHA in the somatostatin group were significantly lower than those in the blank control group(RR=0.45,95%CI:0.33-0.61,P<0.00001;RR=0.51,95%CI:0.39-0.67,P<0.00001).For the short-term injection subgroup,there was no statistical difference between the ratios of PEP and PEHA between the somatostatin group and the blank control group(RR=0.49,95%CI:0.22-1.11,P=0.090;RR=0.88,95%CI:0.450-0.172,P=0.71).For the long-term injection subgroup,the ratio of PEP and PEHA in the somatostatin group was significantly lower than that of the blank control group(RR=0.43,95%CI:0.31-0.59,P<0.00001;RR=0.51,95%CI:0.30-0.69,P<0.00001).For the low-risk PEP subgroup,there was no significant difference in the PEP ratio between the somatostatin group and the blank control group (RR=0.60,95%CI:0.37-0.97,P=0.96).For the high-risk PEP subgroup,the PEP ratio of the somatostatin group was significantly lower than that of the blank control group (RR=0.62,95%CI:0.41-0.93).For the long-term injection of the high-risk PEP subgroup,the PEP ratio of the somatostatin group was significantly lower than that of the blank control group(RR=0.54,95%CI:0.34-0.86,P=0.01).The total rate of abdominal pain after ERCP in the somatostatin group was significantly lower than that of the blank control group (RR=0.60,95%CI:0.33-1.10,P=0.01).The funnel chart of the incidence of PEP showed no asymmetry or negative slope.Conclusion Long-term injection of somatostatin can significantly reduce the incidence of abdominal pain after PEP,PEHA and ERCP in high-risk patients,but it is not necessary for low-risk patients.