title: Pharmacologic prophylaxis of post-endoscopic retrograde cholangiopancreatography pancreatitis: protease inhibitors and NSAIDs in a meta-analysis.
abstract: Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis is the most frequent complication of ERCP. Several meta-analyses have examined the effects of protease inhibitors (gabexate mesilate, ulinastatin, and nafamostat mesilate) and non-steroidal anti-inflammatory drugs (NSAIDs) on post-ERCP pancreatitis, but the results have been confusing. Since the previous meta-analysis, several new studies have been published on this topic. To provide an updated quantitative assessment of the effectiveness of protease inhibitors and NSAIDs in preventing post-ERCP pancreatitis, we conducted a meta-analysis of randomized trials for patients at risk of post-ERCP pancreatitis. Twenty-six articles were included in this meta-analysis. Nafamostat mesilate (summary RR = 0.41; 95 %CI 0.28-0.59; n = 4 studies) and NSAIDs (summary RR = 0.58; 95 %CI = 0.44-0.76; n = 7 studies) were associated with decreased risk of post-ERCP pancreatitis in the high-quality studies. However, gabexate mesilate (summary RR = 0.64; 95 %CI = 0.36-1.13; n = 6 studies) and ulinastatin (summary RR = 0.65; 95 %CI = 0.33-1.30; n = 2 studies) were not associated with decreased risk of post-ERCP pancreatitis in the high-quality studies. This is the first meta-analysis to compare the effects of three protease inhibitors. Solid evidence supports the use of nafamostat mesilate and NSAIDs for preventing post-ERCP pancreatitis.
authors.affiliation: Department of Gastroenterology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, 259-1193, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Yuhara
authors.forename: Masami
authors.initials: M
authors.lastname: Ogawa
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Kawaguchi
authors.forename: Muneki
authors.initials: M
authors.lastname: Igarashi
authors.forename: Tooru
authors.initials: T
authors.lastname: Shimosegawa
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Mine
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001550:Benzamidines; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D006146:Guanidines / Q000627:therapeutic use; D006801:Humans; D010195:Pancreatitis / Q000209:etiology / Q000517:prevention & control*; D011480:Protease Inhibitors / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D001550:Benzamidines; D006146:Guanidines; D011480:Protease Inhibitors; C032855:nafamostat