title: Rectal NSAIDs for the prevention of post-ERCP pancreatitis: a meta-analysis of randomized controlled trials.
abstract: OBJECTIVE
  Acute pancreatitis is the most frequent complication of endoscopic retrograde cholangiopancreatography (ERCP). We conducted a meta-analysis to evaluate the efficacy and safety of rectal nonsteroidal anti-inflammatory drugs (NSAIDs) for the prevention of post-ERCP pancreatitis (PEP).
  
  
  METHODS
  PubMed and Embase databases were searched through April 2013. Results are reported as relative risk (RR) or weighted mean difference (WMD) with 95% confidence interval (95% CI). The primary outcome measure was the incidence of PEP. Secondary outcome measures included the severity of PEP and serum amylase level 2 h, 24 h after ERCP.
  
  
  RESULTS
  Seven trials containing 1846 patients were eligible. Rectal NSAIDs significantly reduced the incidence of PEP (RR 0.45, 95% CI 0.34-0.61, P < 0.001). The results were maintained in subsequent subgroup analysis. Rectal NSAIDs also was associated with a reduction in the incidence of mild PEP (RR 0.54, 95% CI 0.35-0.83, P = 0.005), moderate to severe PEP (RR 0.39, 95% CI 0.22-0.70, P = 0.002), or serum amylase level 2 h after ERCP (WMD -91.09 IU/L, 95% CI -149.78 to -32.40, P = 0.002).
  
  
  CONCLUSIONS
  Rectal NSAIDs reduced the incidence and severity of PEP, as well as serum amylase level 2 h after ERCP.
authors: Department of Biliary Vascular Surgery, Shenjing Hospital of China Medical University, Shenyang 110004, China.
authors: Hong-Li
authors: HL
authors: Sun
authors: Department of Biliary Vascular Surgery, Shenjing Hospital of China Medical University, Shenyang 110004, China.
authors: Bing
authors: B
authors: Han
authors: Department of General Surgery, Central Hospital of Shenyang Medical College, Shenyang 110004, China.
authors: Hong-Peng
authors: HP
authors: Zhai
authors: Department of Biliary Vascular Surgery, Shenjing Hospital of China Medical University, Shenyang 110004, China.
authors: Xin-Hua
authors: XH
authors: Cheng
authors: Department of Biliary Vascular Surgery, Shenjing Hospital of China Medical University, Shenyang 110004, China. Electronic address: makai0311@126.com.
authors: Kai
authors: K
authors: Ma
mesh_terms: D000285:Administration, Rectal; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D006801:Humans; D019283:Pancreatitis, Acute Necrotizing / Q000209:etiology / Q000517:prevention & control*; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal
keywords: Endoscopic retrograde cholangiopancreatography; Meta-analysis; Nonsteroidal anti-inflammatory drugs; Pancreatitis; Rectal