title: Effectiveness of nonsteroidal anti-inﬂammatory drugs in prevention of post-ERCP pancreatitis: a meta-analysis.
abstract: OBJECTIVE
  To investigate the effect of nonsteroidal anti-inﬂammatory drugs (NSAIDs) on the incidence of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP).
  
  
  METHODS
  Two independent reviewers searched PubMed (1966 to October 2013), Embase (1984 to October 2013) and the Cochrane Central Register of Controlled Trials (CENTRAL; Issue 4, 2013) for relevant randomized controlled trials (RCTs) studying the effectiveness of prophylactic NSAID administration in the prevention of PEP. Using the Cochrane Collaboration Handbook, meta-analyses were conducted to evaluate the overall effect of NSAIDs in preventing the incidences of PEP and moderate to severe pancreatitis.
  
  
  RESULTS
  Eight RCTs were identified from the literature search and included 1883 patients that underwent ERCP, with 971 patients in the NSAID group and 912 patients in the placebo group. Sixty-nine out of 971 (7.11%) patients developed PEP in the NSAID group in comparison to 143 out of 912 (15.68%) patients in the placebo group. The pooled RR of PEP incidence with prophylactic NSAID administration was 0.43 (95%CI: 0.33-0.56), which demonstrates that NSAID administration after ERCP significantly reduced the incidence of PEP when compared to the placebo group (P < 0.0001). Subgroup analysis was performed and revealed that the presence (NSAID group) or absence (placebo group) of NSAIDs had no significant effect on the development of moderate to severe pancreatitis (RR = 0.79, 95%CI: 0.52-1.18). Moreover, the administration of NSAIDs as a rectal suppository (RR = 0.35, 95%CI: 0.26-0.48; P < 0.0001) was more effective than oral administration (RR = 0.97, 95%CI: 0.53-1.80) or through infusion (RR = 0.43, 95%CI: 0.12-1.54).
  
  
  CONCLUSIONS
  NSAIDs effectively reduce the incidence of PEP but not of moderate to severe pancreatitis.
authors.affiliation: Xiao Li, Li-Ping Tao, Chun-Hui Wang, Department of Gastroenterology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Xiao
authors.initials: X
authors.lastname: Li
authors.affiliation: Xiao Li, Li-Ping Tao, Chun-Hui Wang, Department of Gastroenterology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Li-Ping
authors.initials: LP
authors.lastname: Tao
authors.affiliation: Xiao Li, Li-Ping Tao, Chun-Hui Wang, Department of Gastroenterology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Chun-Hui
authors.initials: CH
authors.lastname: Wang
mesh_terms: D000284:Administration, Oral; D000285:Administration, Rectal; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D007263:Infusions, Parenteral; D016017:Odds Ratio; D010195:Pancreatitis / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D012307:Risk Factors; D012720:Severity of Illness Index; D013488:Suppositories; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D013488:Suppositories
keywords: Meta-analysis; Nonsteroidal anti-inﬂammatory drugs; Post-endoscopic retrograde cholangiopancreatography pancreatitis; Randomized controlled trial