title: Nonsteroidal anti-inflammatory drugs for prevention of post-ERCP pancreatitis: a meta-analysis.
abstract: BACKGROUND
  The use of nonsteroidal anti-inflammatory drugs (NSAIDs) in the prevention of post-ERCP pancreatitis (PEP) is still controversial.
  
  
  OBJECTIVE
  We performed a meta-analysis to evaluate the efficacy and safety of NSAIDs for PEP prophylaxis.
  
  
  METHODS
  We systematically searched PubMed, EMBASE, Web of Science, and the Cochrane Library for relevant studies published updated to June 2012.
  
  
  METHODS
  Meta-analysis.
  
  
  METHODS
  Patients undergoing ERCP.
  
  
  METHODS
  NSAIDs use for the prevention of PEP.
  
  
  METHODS
  Overall incidence of PEP, incidence of moderate to severe PEP, and adverse events.
  
  
  RESULTS
  Ten RCTs involving 2269 patients were included. Meta-analysis showed that NSAID use decreased the overall incidence of PEP (risk ratio [RR], 0.57; 95% CI, 0.38-0.86; P = .007). The absolute risk reduction was 5.9%. The number needed to treat was 17. Heterogeneity among the studies was substantial. However, after removing the main source of heterogeneity, the prophylactic efficacy was similar (RR, 0.53; 95% CI, 0.41-0.68; P < .001). NSAID use also decreased the incidence of moderate to severe PEP (RR 0.46; 95% CI, 0.28-0.75; P = .002). The absolute risk reduction was 3.0%. The number needed to treat was 34. No differences of the adverse events attributable to NSAIDs were observed.
  
  
  CONCLUSIONS
  Inclusion of low-quality studies, different type and route of administration of the NSAIDs, study heterogeneity, inconsistent use of pancreatic stenting.
  
  
  CONCLUSIONS
  Prophylactic use of NSAIDs reduces the incidence and severity of PEP.
authors.affiliation: Department of Gastroenterology, Drum Tower Hospital Affiliated with Medical School of Nanjing University, Nanjing, China.
authors.forename: Xiwei
authors.initials: X
authors.lastname: Ding
authors.forename: Min
authors.initials: M
authors.lastname: Chen
authors.forename: Shuling
authors.initials: S
authors.lastname: Huang
authors.forename: Song
authors.initials: S
authors.lastname: Zhang
authors.forename: Xiaoping
authors.initials: X
authors.lastname: Zou
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D010195:Pancreatitis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal