Gabexate in the prophylaxis of post-ERCP pancreatitis: a meta-analysis of randomized controlled trials.
BACKGROUND
Acute pancreatitis is a common complication of endoscopic retrograde cholangiopancreatography and the benefit of its pharmacological treatment is unclear. Although prophylactic use of gabexate for the reduction of pancreatic injury after ERCP has been evaluated, the discrepancy about gabexate's beneficial effect on pancreatic injury still exists. This study aimed to evaluate the effectiveness and safety of gabexate in the prophylaxis of post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP).


METHODS
We employed the method recommended by the Cochrane Collaboration to perform a meta-analysis of randomized controlled trials (RCTs) of gabexate in the prevention of post-ERCP pancreatitis (PEP) including three RCTs conducted in Italy and one in China.


RESULTS
All of the four RCTs were of high quality. When the RCTs were analyzed, odds ratios (OR) for gabexate mesilate were 0.67 [95% CI (0.31 to approximately 1.47), p = 0.32] for PEP, 3.78 [95% CI (0.62 to approximately 22.98), p = 0.15] for severe PEP, 0.68 [95% CI (0.19 to approximately 2.43), p = 0.56] for the case-fatality of PEP, 0.88 [95% CI (0.72 to approximately 1.07), p = 0.20] for post-ERCP hyperamylasemia, 0.69 [95% CI (0.39 to approximately 1.21), p = 0.19] for post-ERCP abdominal pain, thus indicating no beneficial effects of gabexate on acute pancreatitis, the death rate of PEP, hyperamylasemia and abdominal pain. No evidence of publication bias was found.


CONCLUSIONS
Gabexate mesilate can not prevent the pancreatic injury after ERCP. It is not recommended for the use of gabexate mesilate in the prophylaxis of PEP.
Zheng
Minghua
M
Department of Infection and Liver Disease, The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, China. blueman1320@163.com <blueman1320@163.com>
Chen
Yongping
Y
Yang
Xinjun
X
Li
Ji
J
Zhang
Youcai
Y
Zeng
Qiqiang
Q
D000208:Acute Disease; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D016670:Gabexate / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D016014:Linear Models; D016017:Odds Ratio; D010195:Pancreatitis / Q000209:etiology / Q000517:prevention & control*; D011183:Postoperative Complications / Q000517:prevention & control*; D011292:Premedication; D016032:Randomized Controlled Trials as Topic; D015842:Serine Proteinase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D018709:Statistics, Nonparametric
D015842:Serine Proteinase Inhibitors; D016670:Gabexate