Prophylactic pancreatic stent placement and post-ERCP pancreatitis: an updated meta-analysis

Background and aim

Pancreatitis is one of the most frequent post-endoscopic retrograde cholangiopancreatography (ERCP) complications. Previous meta-analyses show that prophylactic pancreatic stent (PS) placement after ERCP is beneficial for the prevention of post-ERCP pancreatitis (PEP). However, the results of these meta-analyses are controversial due to the limited sample size of the eligible studies, in which six additional randomized controlled trials (RCTs) are not included. Our aim is, therefore, to update the current meta-analyses regarding PS placement for prevention of PEP.

Methods

We conducted a meta-analysis to identify RCTs comparing PS placement and the subsequent incidence of PEP. The primary outcome was the incidence of PEP.

Results

Fourteen studies were enrolled in this meta-analysis. Of the 1,541 patients, 760 patients received a PS and 781 patients were allocated to the control group. PS placement was associated with a statistically significant reduction of PEP [relative risk (RR) 0.39; 95 % confidence interval (CI) 0.29–0.53; P < 0.001]. Subgroup analysis stratified according to the severity of PEP showed that a PS was beneficial in patients with mild to moderate PEP (RR 0.45; 95 % CI 0.32–0.62; P < 0.001) and in patients with severe PEP (RR 0.26; 95 %CI 0.09–0.76; P = 0.01). In addition, subgroup analysis performed according to patient selection demonstrated that PS placement was effective for both high-risk and mixed case groups.

Conclusions

This meta-analysis showed that PS placement prevented PEP after ERCP as compared with no PS placement. We therefore recommend PS placement after ERCP for the prevention of PEP.     

Nitroglycerin in the Prevention of Post-ERCP Pancreatitis: A Meta-Analysis

The objective of this research paper is to evaluate the effect of prophylactic nitroglycerin in the prevention of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) by performing a meta-analysis of randomized controlled trials (RCTs). Electronic databases, including PubMed, EMBASE, the Cochrane library, and the Science Citation Index, were searched to retrieve relevant trials. Outcome measures were the incidence of PEP. Four RCTs, enrolling a total of 856 patients, were included. Meta-analysis of these trials indicated a significant association between the use of nitroglycerin and the reduction of PEP (RR 0.60; 95%CI: 0.39–0.92; P = 0.02). However, subsequent sensitive analysis failed to confirm that nitroglycerin was statistically superior to a placebo in reducing PEP (RR 0.68; 95%CI: 0.41–1.11; P = 0.12). Based on the limitations in this meta-analysis, prophylactic use of nitroglycerine for all patients who underwent ERCP is not recommended. Further clinical trials are required to confirm the effect of nitroglycerin in the prevention of PEP.     

Can wire‐guided cannulation reduce the risk of post‐endoscopic retrograde cholangiopancreatography pancreatitis? A meta‐analysis of randomized controlled trials

Background and Aim:  The use of wire-guided cannulation (WGC) for prevention of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is controversial. The aim of the present study was to assess the overall effect of WGC for PEP compared with conventional contrast-assisted cannulation by carrying out a meta-analysis of all available randomized controlled trials (RCT).
Methods:  Electronic databases, including PubMed, EMBASE, the Cochrane library and the Science Citation Index, were searched to retrieve relevant trials. In addition, meeting abstracts and the reference lists of retrieved articles were reviewed for further relevant studies. Outcome measures were the incidence of PEP.
Results:  Four RCT, enrolling a total of 1413 patients, were included. The meta-analysis failed to indicate a significant association between the use of WGC and the reduction of PEP (RR 0.34; 95% CI: 0.10–1.17; P  = 0.09). Subgroup analysis including trials without cross-over design showed a significant benefit with the use of WGC in reducing PEP (RR 0.20; 95% CI: 0.09–0.40; P  < 0.00001) and trials without precut used failed to indicate a significant differences between the two group (RR 0.38; 95% CI: 0.01–11.73; P  = 0.58).
Conclusions:  This meta-analysis showed only a non-significant reduction in the rate of PEP with the use of WGC. Further well-designed RCT are required to confirm the effect of WGC, especially in patients who were easier to cannulate.     

Prophylactic Effect of Somatostatin in Preventing Post-ERCP Pancreatitis: An Updated Meta-Analysis

Background/Aims:Somatostatin is regarded as a prophylactic agent on post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP), but studies are still controversial.Results:Eleven randomized controlled trials (RCTs), enrolling a total of 2869 patients, were included in the meta-analysis. After data were pooled from somatostatin trials, PEP occurred in 8.36% of controls versus 5.62% of the treated group, with a slight significance [relative risk (RR) =0.58, 95% confidence interval (CI) 0.35–0.98, P = 0.04]. The funnel plot showed no asymmetry with a negative slope (P = 0.108). The meta-analysis produced negative results for short-term infusion of somatostatin (RR = 1.40, 95% CI 0.93–2.12, P = 0.11), whereas a bolus or long-term injection of the drug proved effective (RR = 0.25, 95% CI 0.13–0.47, P < 0.0001; RR = 0.44, 95% CI 0.27–0.71, P = 0.0008). Postprocedure hyperamylasemia and pain was also observed in the meta-analysis, the pooled RR was significant for reduced risk of postprocedure hyperamylasemia (RR = 0.72, 95%CI 0.63 to 0.81, P < 0.00001), but not for the pain (RR = 0.67, 95% CI 0.42 to 1.08, P = 0.10).Conclusion:The current meta-analysis on the prophylactic use of somatostatin in patients undergoing ERCP documents a lack of benefit when given as short-term infusion, but showed an advantage of a single bolus or long-term injection. The beneficial effect of somatostatin, in reducing the incidence of postprocedural hyperamylasemia seems of marginal clinical significance. However, more new confirmatory data are needed to settle residual doubts.     

Post-ERCP pancreatitis

Pancreatitis remains the most common severe complication of endoscopic retrograde cholangiopancreatography (ERCP). Detailed information about the findings of previous studies concerning post-ERCP pancreatitis has not been utilized sufficiently. The purpose of the present article was to present guidelines for the diagnostic criteria of post-ERCP pancreatitis, and its incidence, risk factors, and prophylactic procedures that are supported by evidence. To achieve this purpose, a critical examination was made of the articles on post-ERCP pancreatitis, based on the data obtained by research studies published up to 2009. At present, there are no standardized diagnostic criteria for post-ERCP pancreatitis. It is appropriate that post-ERCP pancreatitis is defined as acute pancreatitis that has developed following ERCP, and its diagnosis and severity assessment should be made according to the diagnostic criteria and severity assessment of the Japanese Ministry of Health, Labour and Welfare. The incidence of acute pancreatitis associated with diagnostic and therapeutic ERCP is 0.4–1.5 and 1.6–5.4%, respectively. Endoscopic papillary balloon dilation is associated with a high risk of acute pancreatitis compared with endoscopic sphincterotomy. It was made clear that important risk factors include dysfunction of the Oddi sphincter, being of the female sex, past history of post-ERCP pancreatitis, and performance of pancreaticography. Temporary prophylactic placement of pancreatic stents in the high-risk group is useful for the prevention of post-ERCP pancreatitis [odds ratio (OR) 3.2, 95% confidence interval (CI) 1.6–6.4, number needed to treat (NNT) 10]. Use of nonsteroidal anti-inflammatory drugs (NSAIDs) is associated with a reduction in the development of post-ERCP pancreatitis (OR 0.46, 95% CI 0.32–0.65). Single rectal administration of NSAIDs is useful for the prevention of post-ERCP pancreatitis [relative risk (RR) 0.36, 95% CI 0.22–0.60, NNT 15] and decreases the development of pancreatitis in both the low-risk group (RR 0.29, 95% CI 0.12–0.71) and the high-risk group (RR 0.40, 95% CI 0.23–0.72) of post-ERCP pancreatitis. As for somatostatin, a bolus injection may be most useful compared with short- or long-term infusion (OR 0.271, 95% CI 0.138–0.536, risk difference 8.2%, 95% CI 4.4–12.0%). The usefulness of gabexate mesilate was not apparent in any of the following conditions: acute pancreatitis (control 5.7 vs. 4.8% for gabexate mesilate), hyperamylasemia (40.6 vs. 36.9%), and abdominal pain (1.7 vs. 8.9%). Formulation of diagnostic criteria for post-ERCP pancreatitis is needed. Temporary prophylactic placement of pancreatic stents in the high-risk group offers the most promise as a means of preventing post-ERCP pancreatitis. As for pharmacological attempts, there are high expectations concerning NSAIDs because they are excellent in terms of cost-effectiveness, ease of use, and safety. There was no evidence of effective prophylaxis with the use of protease inhibitors, especially gabexate mesilate.     

导丝引导胆管选择性插管对ERCP术后胰腺炎影响的系统评价

目的 系统评价导丝引导胆管选择性插管与传统地造影剂辅助插管相比,能否降低ERCP术后胰腺炎(post-ERCP panereatitis,PEP)的发生率.方法 检索Cochrane临床对照试验资料库、MEDLINE、EMBASE、Science Citation Index、中国生物医学文献数据库,以及2002-2008年相关会参考文献,全面收集关于导丝引导胆管选择性插管对PEP影响的文摘,并且手工检索入选文献的议随机对照试验进行Meta分析.结果 共7篇随机对照试验包括2474例胆管选择性插管的ERCP患者被纳入评价.Meta分析结果显示,导丝引导胆管选择性插管和造影剂辅助插管比较,可降低PEP发生率(RR=0.46,95%可信区间0.25～0.85,P=0.01).但是,排除摘要和分配隐藏不清楚的试验进行敏感性分析后,两个插管方法 对PEP发生率差异无统计学意义(RR=0.66,95%可信区间0.28～1.54,P=0.33).结论 导丝引导胆管选择性插管可能是减少PEP发生的有效方法 ,但由于纳入系统评价的试验有限,还需开展随机对照试验证实.     

导丝引导胆管选择性插管对ERCP术后胰腺炎影响的系统评价

目的系统评价导丝引导胆管选择性插管与传统地造影剂辅助插管相比，能否降低ERCP术后胰腺炎（post—ERCP panereatitis，PEP）的发生率。方法检索Cochrane临床对照试验资料库、MEDLINE、EMBASE、Science Citation Index、中国生物医学文献数据库，以及2002—2008年相关会议文摘，并且手工检索人选文献的参考文献，全面收集关于导丝引导胆管选择性插管对PEP影响的随机对照试验进行Meta分析。结果共7篇随机对照试验包括2474例胆管选择性插管的ERCP患者被纳入评价。Meta分析结果显示，导丝引导胆管选择性插管和造影剂辅助插管比较，可降低PEP发生率（RR=0．46，95％可信区间0．25～0．85，P=0．01）。但是，排除摘要和分配隐藏不清楚的试验进行敏感性分析后，两个插管方法对PEP发生率差异无统计学意义（RR=0．66，95％可信区间0．28～1．54，P=0．33）。结论导丝引导胆管选择性插管可能是减少PEP发生的有效方法，但由于纳入系统评价的试验有限，还需开展随机对照试验证实。     

导丝引导胆管选择性插管对ERCP术后胰腺炎影响的系统评价

目的 系统评价导丝引导胆管选择性插管与传统地造影剂辅助插管相比,能否降低ERCP术后胰腺炎(post-ERCP panereatitis,PEP)的发生率.方法 检索Cochrane临床对照试验资料库、MEDLINE、EMBASE、Science Citation Index、中国生物医学文献数据库,以及2002-2008年相关会参考文献,全面收集关于导丝引导胆管选择性插管对PEP影响的文摘,并且手工检索入选文献的议随机对照试验进行Meta分析.结果 共7篇随机对照试验包括2474例胆管选择性插管的ERCP患者被纳入评价.Meta分析结果显示,导丝引导胆管选择性插管和造影剂辅助插管比较,可降低PEP发生率(RR=0.46,95%可信区间0.25～0.85,P=0.01).但是,排除摘要和分配隐藏不清楚的试验进行敏感性分析后,两个插管方法 对PEP发生率差异无统计学意义(RR=0.66,95%可信区间0.28～1.54,P=0.33).结论 导丝引导胆管选择性插管可能是减少PEP发生的有效方法 ,但由于纳入系统评价的试验有限,还需开展随机对照试验证实.     

导丝引导胆管选择性插管对ERCP术后胰腺炎影响的系统评价

目的 系统评价导丝引导胆管选择性插管与传统地造影剂辅助插管相比,能否降低ERCP术后胰腺炎(post-ERCP panereatitis,PEP)的发生率.方法 检索Cochrane临床对照试验资料库、MEDLINE、EMBASE、Science Citation Index、中国生物医学文献数据库,以及2002-2008年相关会参考文献,全面收集关于导丝引导胆管选择性插管对PEP影响的文摘,并且手工检索入选文献的议随机对照试验进行Meta分析.结果 共7篇随机对照试验包括2474例胆管选择性插管的ERCP患者被纳入评价.Meta分析结果显示,导丝引导胆管选择性插管和造影剂辅助插管比较,可降低PEP发生率(RR=0.46,95%可信区间0.25～0.85,P=0.01).但是,排除摘要和分配隐藏不清楚的试验进行敏感性分析后,两个插管方法 对PEP发生率差异无统计学意义(RR=0.66,95%可信区间0.28～1.54,P=0.33).结论 导丝引导胆管选择性插管可能是减少PEP发生的有效方法 ,但由于纳入系统评价的试验有限,还需开展随机对照试验证实.     

导丝引导胆管选择性插管对ERCP术后胰腺炎影响的系统评价

目的 系统评价导丝引导胆管选择性插管与传统地造影剂辅助插管相比,能否降低ERCP术后胰腺炎(post-ERCP panereatitis,PEP)的发生率.方法 检索Cochrane临床对照试验资料库、MEDLINE、EMBASE、Science Citation Index、中国生物医学文献数据库,以及2002-2008年相关会参考文献,全面收集关于导丝引导胆管选择性插管对PEP影响的文摘,并且手工检索入选文献的议随机对照试验进行Meta分析.结果 共7篇随机对照试验包括2474例胆管选择性插管的ERCP患者被纳入评价.Meta分析结果显示,导丝引导胆管选择性插管和造影剂辅助插管比较,可降低PEP发生率(RR=0.46,95%可信区间0.25～0.85,P=0.01).但是,排除摘要和分配隐藏不清楚的试验进行敏感性分析后,两个插管方法 对PEP发生率差异无统计学意义(RR=0.66,95%可信区间0.28～1.54,P=0.33).结论 导丝引导胆管选择性插管可能是减少PEP发生的有效方法 ,但由于纳入系统评价的试验有限,还需开展随机对照试验证实.     

导丝引导胆管选择性插管对ERCP术后胰腺炎影响的系统评价

目的 系统评价导丝引导胆管选择性插管与传统地造影剂辅助插管相比,能否降低ERCP术后胰腺炎(post-ERCP panereatitis,PEP)的发生率.方法 检索Cochrane临床对照试验资料库、MEDLINE、EMBASE、Science Citation Index、中国生物医学文献数据库,以及2002-2008年相关会参考文献,全面收集关于导丝引导胆管选择性插管对PEP影响的文摘,并且手工检索入选文献的议随机对照试验进行Meta分析.结果 共7篇随机对照试验包括2474例胆管选择性插管的ERCP患者被纳入评价.Meta分析结果显示,导丝引导胆管选择性插管和造影剂辅助插管比较,可降低PEP发生率(RR=0.46,95%可信区间0.25～0.85,P=0.01).但是,排除摘要和分配隐藏不清楚的试验进行敏感性分析后,两个插管方法 对PEP发生率差异无统计学意义(RR=0.66,95%可信区间0.28～1.54,P=0.33).结论 导丝引导胆管选择性插管可能是减少PEP发生的有效方法 ,但由于纳入系统评价的试验有限,还需开展随机对照试验证实.     

导丝引导胆管选择性插管对ERCP术后胰腺炎影响的系统评价

目的 系统评价导丝引导胆管选择性插管与传统地造影剂辅助插管相比,能否降低ERCP术后胰腺炎(post-ERCP panereatitis,PEP)的发生率.方法 检索Cochrane临床对照试验资料库、MEDLINE、EMBASE、Science Citation Index、中国生物医学文献数据库,以及2002-2008年相关会参考文献,全面收集关于导丝引导胆管选择性插管对PEP影响的文摘,并且手工检索入选文献的议随机对照试验进行Meta分析.结果 共7篇随机对照试验包括2474例胆管选择性插管的ERCP患者被纳入评价.Meta分析结果显示,导丝引导胆管选择性插管和造影剂辅助插管比较,可降低PEP发生率(RR=0.46,95%可信区间0.25～0.85,P=0.01).但是,排除摘要和分配隐藏不清楚的试验进行敏感性分析后,两个插管方法 对PEP发生率差异无统计学意义(RR=0.66,95%可信区间0.28～1.54,P=0.33).结论 导丝引导胆管选择性插管可能是减少PEP发生的有效方法 ,但由于纳入系统评价的试验有限,还需开展随机对照试验证实.     

导丝引导胆管选择性插管对ERCP术后胰腺炎影响的系统评价

目的 系统评价导丝引导胆管选择性插管与传统地造影剂辅助插管相比,能否降低ERCP术后胰腺炎(post-ERCP panereatitis,PEP)的发生率.方法 检索Cochrane临床对照试验资料库、MEDLINE、EMBASE、Science Citation Index、中国生物医学文献数据库,以及2002-2008年相关会参考文献,全面收集关于导丝引导胆管选择性插管对PEP影响的文摘,并且手工检索入选文献的议随机对照试验进行Meta分析.结果 共7篇随机对照试验包括2474例胆管选择性插管的ERCP患者被纳入评价.Meta分析结果显示,导丝引导胆管选择性插管和造影剂辅助插管比较,可降低PEP发生率(RR=0.46,95%可信区间0.25～0.85,P=0.01).但是,排除摘要和分配隐藏不清楚的试验进行敏感性分析后,两个插管方法 对PEP发生率差异无统计学意义(RR=0.66,95%可信区间0.28～1.54,P=0.33).结论 导丝引导胆管选择性插管可能是减少PEP发生的有效方法 ,但由于纳入系统评价的试验有限,还需开展随机对照试验证实.     

导丝引导胆管选择性插管对ERCP术后胰腺炎影响的系统评价

目的 系统评价导丝引导胆管选择性插管与传统地造影剂辅助插管相比,能否降低ERCP术后胰腺炎(post-ERCP panereatitis,PEP)的发生率.方法 检索Cochrane临床对照试验资料库、MEDLINE、EMBASE、Science Citation Index、中国生物医学文献数据库,以及2002-2008年相关会参考文献,全面收集关于导丝引导胆管选择性插管对PEP影响的文摘,并且手工检索入选文献的议随机对照试验进行Meta分析.结果 共7篇随机对照试验包括2474例胆管选择性插管的ERCP患者被纳入评价.Meta分析结果显示,导丝引导胆管选择性插管和造影剂辅助插管比较,可降低PEP发生率(RR=0.46,95%可信区间0.25～0.85,P=0.01).但是,排除摘要和分配隐藏不清楚的试验进行敏感性分析后,两个插管方法 对PEP发生率差异无统计学意义(RR=0.66,95%可信区间0.28～1.54,P=0.33).结论 导丝引导胆管选择性插管可能是减少PEP发生的有效方法 ,但由于纳入系统评价的试验有限,还需开展随机对照试验证实.     

导丝引导胆管选择性插管对ERCP术后胰腺炎影响的系统评价

目的 系统评价导丝引导胆管选择性插管与传统地造影剂辅助插管相比,能否降低ERCP术后胰腺炎(post-ERCP panereatitis,PEP)的发生率.方法 检索Cochrane临床对照试验资料库、MEDLINE、EMBASE、Science Citation Index、中国生物医学文献数据库,以及2002-2008年相关会参考文献,全面收集关于导丝引导胆管选择性插管对PEP影响的文摘,并且手工检索入选文献的议随机对照试验进行Meta分析.结果 共7篇随机对照试验包括2474例胆管选择性插管的ERCP患者被纳入评价.Meta分析结果显示,导丝引导胆管选择性插管和造影剂辅助插管比较,可降低PEP发生率(RR=0.46,95%可信区间0.25～0.85,P=0.01).但是,排除摘要和分配隐藏不清楚的试验进行敏感性分析后,两个插管方法 对PEP发生率差异无统计学意义(RR=0.66,95%可信区间0.28～1.54,P=0.33).结论 导丝引导胆管选择性插管可能是减少PEP发生的有效方法 ,但由于纳入系统评价的试验有限,还需开展随机对照试验证实.     

导丝引导胆管选择性插管对ERCP术后胰腺炎影响的系统评价

目的 系统评价导丝引导胆管选择性插管与传统地造影剂辅助插管相比,能否降低ERCP术后胰腺炎(post-ERCP panereatitis,PEP)的发生率.方法 检索Cochrane临床对照试验资料库、MEDLINE、EMBASE、Science Citation Index、中国生物医学文献数据库,以及2002-2008年相关会参考文献,全面收集关于导丝引导胆管选择性插管对PEP影响的文摘,并且手工检索入选文献的议随机对照试验进行Meta分析.结果 共7篇随机对照试验包括2474例胆管选择性插管的ERCP患者被纳入评价.Meta分析结果显示,导丝引导胆管选择性插管和造影剂辅助插管比较,可降低PEP发生率(RR=0.46,95%可信区间0.25～0.85,P=0.01).但是,排除摘要和分配隐藏不清楚的试验进行敏感性分析后,两个插管方法 对PEP发生率差异无统计学意义(RR=0.66,95%可信区间0.28～1.54,P=0.33).结论 导丝引导胆管选择性插管可能是减少PEP发生的有效方法 ,但由于纳入系统评价的试验有限,还需开展随机对照试验证实.     

Prophylactic Corticosteroids Do Not Prevent Post-ERCP Pancreatitis: A Meta-Analysis of Randomized Controlled Trials

Background: Data regarding the use of corticosteroids for the prevention of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis are conflicting. The aim of this meta-analysis was to compare corticosteroids with placebo for prevention of post-ERCP pancreatitis. Methods: Multiple databases including MEDLINE, EMBASE, Cochrane controlled trials register, the Cochrane Library, Science Citation Index, Google Scholar and Google updated to June 2007 were searched to retrieve the relevant randomized controlled trials. Primary outcome measure was post-ERCP pancreatitis. Results: Six randomized controlled trials involving 2,448 patients were identified. The analysis showed that corticosteroids did not prevent post-ERCP pancreatitis (OR 1.13:95% CI [0.88,1.46]). Subsequent sensitivity and subgroup analyses according to different criteria all confirmed these results. Conclusions: Based on available evidence, prophylactic corticosteroids do not reduce the incidence of post-ERCP pancreatitis.     

Systematic review and meta-analysis on the prophylactic role of non-steroidal anti-inflammatory drugs to prevent post-endoscopic retrograde cholangiopancreatography pancreatitis

AIM: To critically appraise the published randomized, controlled trials on the prophylactic effectiveness of the non-steroidal anti-inflammatory drugs(NSAIDs), in reducing the risk of post-endoscopic retrograde cholangiopancreatography(ERCP) pancreatitis. METHODS: A systematic literature search(MEDLINE, Embase and the Cochrane Library, from inception of the databases until May 2015) was conducted to identify randomized, clinical trials investigating the role of NSAIDs in reducing the risk of post-ERCP pancreatitis. Random effects model of the meta-analysis was carried out, and results were presented as odds ratios(OR) with corresponding 95%CI.RESULTS: Thirteen randomized controlled trials on 3378 patients were included in the final meta-analysis. There were 1718 patients in the NSAIDs group and 1660 patients in non-NSAIDs group undergoing ERCP. The use of NSAIDs(through rectal route or intramuscular route) was associated with the reduced risk of post-ERCP pancreatitis [OR, 0.52(0.38-0.72), P = 0.0001]. The use of pre-procedure NSAIDs was effective in reducing approximately 48% incidence of post-ERCP pancreatitis, number needed to treat were 16 with absolute risk reduction of 0.05. But the risk of post-ERCP pancreattis was reduced by 55% if NSAIDs were administered after procedure. Similarly, diclofenac was more effective(55%) prophylactic agent compared to indomethacin(41%).CONCLUSION: NSAIDs seem to have clinically proven advantage of reducing the risk of post-ERCP pancreatitis.     

Updated meta-analysis of pancreatic stent placement in preventing post-endoscopic retrograde cholangiopancreatography pancreatitis

AIM: To investigate the efficacy and safety profile of pancreatic duct (PD) stent placement for prevention of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP).METHODS: We performed a search of MEDLINE, EMBASE, and Cochrane Library to identify randomized controlled clinical trials of prophylactic PD stent placement after ERCP. RevMan 5 software provided by Cochrane was used for the heterogeneity and efficacy analyses, and a meta-analysis was performed for the data that showed homogeneity. Categorical data are presented as relative risks and 95% confidence intervals (CIs), and measurement data are presented as weighted mean differences and 95%CIs.RESULTS: The incidence rates of severe pancreatitis, operation failure, complications and patient pain severity were analyzed. Data on pancreatitis incidence were reported in 14 of 15 trials. There was no significant heterogeneity between the trials (I² = 0%, P = 0.93). In the stent group, 49 of the 1233 patients suffered from PEP, compared to 133 of the 1277 patients in the no-stent group. The results of this meta-analysis indicate that it may be possible to prevent PEP by placing a PD stent.CONCLUSION: PD stent placement can reduce postoperative hyperamylasemia and might be an effective and safe option to prevent PEP if the operation indications are well controlled.     

Rectal indomethacin with topical epinephrine versus indomethacin alone for preventing Post-ERCP pancreatitis – A systematic review and meta-analysis

BackgroundRecent studies have compared the utility of rectal indomethacin with topical epinephrine (IE) sprayed on duodenal papilla and rectal indomethacin alone (IS) to prevent post-ERCP pancreatitis (PEP) with conflicting results. We performed a systematic review and meta-analysis to evaluate the benefit of using the combination prophylaxis as oppose to rectal indomethacin alone.MethodsThe following database were searched for our systematic review: PubMed∖Medline, Embase, Cochrane, and Web of Science. We included both randomized controlled trials (RCTs) and cohort studies. Primary outcome was incidence of PEP and secondary outcomes were adverse events and mortality.ResultsA total of 3 studies (all RCTs) with 2244 patients (1132 in IS and 1112 in IE group) were included. The IE group did not demonstrate any significant benefit over IS group in preventing PEP (RR: 1.15, 95% CI 0.62–2.2), mortality (RR: 0.85, 95% CI 0.22–3.24) or overall adverse events (RR: 1.3, 95% CI 0.93–1.7).ConclusionThe combination of rectal indomethacin and topical epinephrine failed to demonstrate any benefit over indomethacin alone in preventing PEP, decreasing mortality and overall adverse events.