title: Nafamostat mesilate for prevention of post-ERCP pancreatitis: a meta-analysis of prospective, randomized, controlled trials.
abstract: OBJECTIVE
  We aimed to evaluate the efficacy of nafamostat on the prevention of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP).
  
  
  METHODS
  Medline, Embase, Cochrane Central Register of Controlled Trials, and Web of Science were searched until April 18, 2014.
  
  
  RESULTS
  Seven randomized controlled trials and 2956 patients met the search criteria. When compared with nonnafamostat, the incidence of PEP was reduced to 53% in the patients who received nafamostat (risk ratio [RR], 0.47; 95% confidence interval [CI], 0.34-0.63). Further analyses were conducted based on the different risk classifications (n = 641 in patients with high risks: RR, 0.54; 95% CI, 0.30-0.96 and n = 944 with low risks: RR, 0.31; 95% CI, 0.17-0.56), PEP severities (n = 1654: RR, 0.38; 95% CI, 0.25-0.59 for mild; RR, 0.37; 95% CI, 0.15-0.96 for moderate; RR, 0.92; 95% CI, 0.13-6.38 for severe), and nafamostat doses (n = 1902: RR, 0.42; 95% CI, 0.28-0.63 for 20 mg; n = 1150: RR, 0.40; 95% CI, 0.25-0.63 for 50 mg). However, there was no reduction of the incidence of post-ERCP hyperamylasemia (n = 1585; 95% CI, 0.68-1.45) or cannulation difficulty (n = 1585; 95% CI, 0.91-1.23).
  
  
  CONCLUSIONS
  Pooled analyses from current randomized controlled trials support the effectiveness of nafamostat for prophylaxis of PEP.
authors.affiliation: From the *Department of Gastroenterology, Shanghai First People's Hospital, Shanghai Jiaotong University School of Medicine; and †Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China.
authors.forename: Ge
authors.initials: G
authors.lastname: Yu
authors.forename: Shuang
authors.initials: S
authors.lastname: Li
authors.forename: Rong
authors.initials: R
authors.lastname: Wan
authors.forename: Xingpeng
authors.initials: X
authors.lastname: Wang
authors.forename: Guoyong
authors.initials: G
authors.lastname: Hu
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; D015233:Models, Statistical; D010195:Pancreatitis / Q000209:etiology / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D001550:Benzamidines; D006146:Guanidines; C032855:nafamostat