Meta-analysis of prophylactic corticosteroid use in post-ERCP pancreatitis.
BACKGROUND
Acute pancreatitis is a common complication of endoscopic retrograde cholangiopancreatography and benefit of pharmacological treatment is unclear. Although prophylactic use of corticosteroid for reduction of pancreatic injury after ERCP has been evaluated, discrepancy about beneficial effect of corticosteroid on pancreatic injury still exists. The aim of current study is to evaluate effectiveness and safety of corticosteroid in prophylaxis of post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP).


METHODS
We employed the method recommended by the Cochrane Collaboration to perform a meta-analysis of seven randomized controlled trials (RCTs) of corticosteroid in prevention of post-ERCP pancreatitis (PEP) around the world.


RESULTS
Most of the seven RCTs were of high quality. When the RCTs were analyzed, odds ratios (OR) for corticosteroid were 1.13 [95% CI (0.89~1.44), p = 0.32] for PEP, 1.61 [95% CI (0.74~3.52), p = 0.23] for severe PEP, 0.92 [95% CI (0.57~1.48), p = 0.73] for post-ERCP hyperamylasemia respectively. The results indicated that there were no beneficial effects of corticosteroid on acute pancreatitis and hyperamylasemia. No evidence of publication bias was found.


CONCLUSIONS
Corticosteroids cannot prevent pancreatic injury after ERCP. Therefore, their use in the prophylaxis of PEP is not recommended.
Zheng
Minghua
M
Department of Infection and Liver Diseases, The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, China. blueman1320@163.com
Bai
Jianling
J
Yuan
Bosi
B
Lin
Feng
F
You
Jie
J
Lu
Mingqin
M
Gong
Yuewen
Y
Chen
Yongping
Y
D000208:Acute Disease; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D005938:Glucocorticoids / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D010179:Pancreas / Q000187:drug effects; D010195:Pancreatitis / Q000209:etiology* / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D012107:Research Design
D005938:Glucocorticoids